Claims Examiner II
$65,416–$78,499 year
On-siteSanta Rosa, California, United States or Chico, California, United States
Job Summary
Review, research, and resolve pended Medi-Cal claims across medical, ancillary, long-term care, and batch types within established production and quality standards. Complete claims from batch reports, generate provider correspondence, and route complex cases to Partnership departments for additional review. Adhere to State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS rules while recording daily production statistics and submitting logs to the supervisor. Identify pending claim trends, submit audit adjustments, and provide feedback on procedure changes to improve operational efficiency.
Required Qualifications
- High school diploma or equivalent
- Minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment
- Ability to use a microcomputer keyboard
- Ability to move, carry, or lift objects of varying size, weighing up to 5 lbs
Desired Qualifications
- Knowledge of claims processing and/or Medi-Cal billing
- CPT knowledge
- ICD-10 knowledge
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