MEDICAL CLAIMS EXAMINER NEEDED! - Los Angeles California

Location: Los Angeles, California
Posted On: 02/03/2025

Well known Health Care Organization has immediate opening for a Medical Claims Examiner. You will be responsible for the accurate and timely processing of direct contract and delegated claims per regulatory and contractual guidelines. You will process claims for all lines of business, including complex claims, monitor itemized billings for excessive charges, duplication, unbundling, and medical coding, determine prior authorization/precertification of services paid via system and/or health services, and review claims for required information, pending claims when necessary, maintain a follow-up system, and update and release pending claims when indicated. Looking for someone with at least six years of years of health care claims processing experience in a managed care environment and strong experience in handling complicated claims cases. Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-9, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge is required. Previous Medi-Cal claims processing experience and knowledge of State Department of Health Services regulations is highly preferred. Must have knowledge of Medicare claims processing. Bilingual Spanish is a plus. Email resume as a word attachment to Paris Goldfarb.

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status. More...

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