CLAIMS EXAMINER I MSO
$79,040–$79,040 year
On-siteBurlingame, California, United States
Burlingame, California, United StatesOn-siteFull Time$79,040–$79,040 year
Full Time
Job Summary
Review, audit, and adjudicate professional claims daily based on Medi-Cal, Medicare, and MSO Claims Manual guidelines. Correct pre-payment report errors, identify NEMS billing issues, and resolve system configuration flaws reported to the configuration team. Respond to first-level provider inquiries regarding denials and payment status while maintaining a weekly production standard of 750 claims. Assist the Claims Supervisor with health plan delegation oversight audits and special projects as needed. Fluently speak, read, and write English. FLSA non-exempt position.
Required Qualifications
- Completion of a 2-year degree from an accredited University, may be substituted with relevant work experience in healthcare medical claims processing and examination field
- Excellent data entry skills
- Must be able to fluently speak, read and write English
- Ability to self-manage in a detail-oriented environment
- Good organization and prioritization skills, outstanding in time management
Desired Qualifications
- Two years' experience in health insurance claims processing, examination, and adjudication preferred
- Working knowledge of managed care and/or healthcare claim reimbursement or medical billing in Medi-Cal and Medicare Advantage program preferred
- Working knowledge of State/Federal healthcare compliance requirements (HIPAA, AB1455, and ICE standards), particularly DHCS/Medi-Cal and/or CMS/Medicare guidelines preferred
- Working knowledge of medical terminology, standard code sets, and claim forms preferred
- Ability to operate PC based software programs or automated database management systems preferred
- Fluent in other languages are an asset
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