Examiner II, Claims at AltaMed Health Services in Montebello, California

Job Description:

Position Title: Examiner II, Claims

Location: Montebello, CA 90640

Post Date: Posted Yesterday

Description:

Work Boldly. Live Brilliantly.
At AltaMed, we don’t just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It’s the calling of our lives and it compels us to keep moving forward.

Job Overview

A Claims Examiner is responsible for analyzing and the adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or from claims incident/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and Incidents. Collaborates with other departments and/or providers in successful resolution of claims related issues.

Minimum Requirements

1. HS Diploma or GED

2. 3+ years of Claims Processing experience in a managed care environment.

3. Must be knowledgeable of Medi-cal regulations.

4. Preferred knowledge of Medicare and Commercial rules and regulations.

5. Knowledge of medical terminology.

6. Must have an understanding to read and interpret DOFRs and Contracts.

7. Must have an understanding how to read a CMS-1500 and UB-04 form.

8. Must have strong organizational and mathematical skills.

Benefits & Career Development

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance

Salary Range

$26.13 - $32.55 hourly

Remote Type: Hybrid


About US:

Quality Care Without Exception

Bold decisions and innovative thinking have helped AltaMed become the nation’s largest network of community-based primary care facilities and senior care programs. We are Joint Commission accredited health system focused on preventative medicine and the elimination of health care disparities throughout Southern California.

At AltaMed, we empower over 4,000 employees in medicine, nursing, social work, dentistry, mental health, and health administration to work boldly – bringing their best ideas and greatest strengths to our facilities every day – and to live brilliantly, applying that same energy and purpose to their lives and communities outside.

Explore our opportunities throughout Los Angeles and Orange counties and take your career to the highest level.

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