Job Description

ESSENTIAL JOB RESPONSIBILITIES:

• Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services.
• Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations.
• Review different payors to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines.
• Support accounts payable activities for accurate and timely processing.
• Complete coding and record accounts payable entries.
• Process refunds, appeals, disputes, and adjustments (when applicable).
• Participate in accounts payable processes.
• Identify process improvement opportunities and recommend enhancements.
• Handles any additional responsibility as assigned.

EDUCATION AND QUALIFICATIONS:

• High School diploma or GED equivalent. Associate's degree in related field is preferred.
• Minimum of one (1) year related experience required.
• Experience in medical/insurance preferred.
• Team-centered with excellent work ethic and reliability.
• Experience with UB/institutional (CMS-UB04) and HCFA/professional (CMS-1500) claims preferred.
• Familiarity with medical terminology, procedure and diagnosis codes preferred.
• Ability to calculate figures and co-insurance amounts.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.