Medical Claims Examiner jobs in the Healthcare Services industry

CLAIMS EXAMINER/SENIOR CLAIMS EXAMINER Seasoned professional medical claims examiner, with several years of experience reviewing and processing claims in a fast-paced environment. Must have proven communication and analytical skills,understand policy provisions and interpret complex medical terms and procedures consistently applying Fund office standards and policy in the adjudication of claims. A...
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Medical Claims Examiner M-F, 40/hr/week Able to meet production standards At Least 5+ Years Recent Experience Experience with HMO, Managed Care, Medicare, Medi-Cal, Commercial, Professional, Institutional, Senior, DRG/RCC rates, ICD-9, anesthesia claims, in-patient claims, SNF, DME, dialysis, chemo, stop loss or case rates, COB, outpatient surgeries, ER and all other claim types...
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JOB DESCRIPTION:Examiner, Claims - CFHP Claims Department JOB CLASS:4951 REVIEWED:05/06 POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children?s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE High sc...
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JOB DESCRIPTION DATE: May 1, 2013 SUBJECT: Medical/Dental/Vision Claims Processor Position Job Location: 444 Irving Drive #202, Burbank, CA 91504 Availability: IMMEDIATE Please apply only if you possess the requirements below Position Summary and Experience This position is a senior level position for individuals with a minimum of three years experience processing medical, dental and vision claims...
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Job Summary Claims Processing of complex claims (stop loss, etc.) and adjudication and claims research when necessary. Must meet and/or exceed qualitative and quantitative production standards. Provides informational resource for employees, assist in training new staff, handle difficult claims. Essential Functions • Quality Standard - Meet and Maintain quality standard for position. • Claims Adjud...
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POSITION SUMMARY Claims Processing and adjudication of more complex CMS 1500 claims as well as processing of UB claims for specific services. Assists with claims research when necessary. Must meet and/or exceed qualitative production standards. ESSENTIAL FUNCTIONS Duties and Responsibilities • Quality Standard - Meet and Maintain the quality rate. • Claims Adjudication - Meet and consistently main...
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JOB TITLE: Examiner, Senior Claims - CFHP JOB CLASS NUMBER: 4952 REVISED: 6/06 POSITION SUMMARY/RESPONSIBILITIES Performs review, analysis, and adjudication of all claim types including coordination of benefits and DME claims. Performs analysis of provider appeals and documents outcome determination via correspondence. Acts as a provider liaison for claim issue resolution by utilization of appropr...
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Position Summary The Medical Biller will run all claims (HCFA, UB04’s) on a biweekly basis, review claims for completeness or errors, fix all minor errors, such as missing CPT codes, ICD-9 codes, sign, address envelopes and mail out. Schedule: · Full-time(Non-Exempt) · Flexible, may require some evening and weekends Primary Duties and Responsibilities · Electronically transmit the Medi/Cal data. ·...
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RN Field Case Manager Job Description and Candidate Information Summary Seeking FT Nurse to service Northern California (Contra Costa County and surrounding counties in SF Bay Area). Field nurse may work from Corporate office and or from their home providing medical case management services to persons whom were injured on the job. The nurse will use medical expertise combined with knowledge of the...
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Description: 523802: Supervisor of Investigators - Eden Prairie, MN Job Description Health care fraud is a serious problem affecting every patient and consumer. The devastating situation is rooted not only in the excessive financial losses incurred, which extend into the billions of dollars every year, but also in patient harm. According to the National Health Care Antifraud Association (NHCAA), h...
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Description: 519615: Healthcare Fraud Senior Investigator - Eden Prairie, MN / Franklin, TN / Miramar, FL Job Description Health care fraud is a serious problem affecting every patient and consumer. The devastating situation is rooted not only in the excessive financial losses incurred, which extend into the billions of dollars every year, but also in patient harm. According to the National Health...
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Description: 519626: Healthcare Fraud Investigations and Settlements Consultant - Eden Prairie, MN / Franklin, TN / Miramar, FL Job Description Health care fraud is a serious problem affecting every patient and consumer. The devastating situation is rooted not only in the excessive financial losses incurred, which extend into the billions of dollars every year, but also in patient harm. According ...
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Description: The Fraud Analyst position is responsible for identifying and analyzing claims data and categorizing areas of fraud, waste and abuse within a Medicare Advantage plan. This position requires proactive analytics and data mining to assist in identifying potential fraudulent activity and requires a well developed understanding of the health insurance industry and an in-depth understanding...
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Laboratory Billing Specialist Job Description - Summary The Claims Examiner will be responsible for all back-end billing functions and will report directly to the Manager, Revenue Life Cycle Dept. The Claims Examinerresponsibilities will include: · Posting payments and denials from state, federal, and commercial insurance payers · Reviewing claim determinations, filing appeals, correcting and resu...
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