SENIOR CLAIMS EXAMINER, PIH HEALTH PHYSICIANS, FULL TIME, DAYSApply Now Job ID 11706-977 Date posted 04/07/2021
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
The Senior Claims Examiner administers health plan contracts by processing medical claims in an efficient, cost-effective, and timely manner meeting all required guidelines and performs adjustments as necessary. Some of the duties include handling of Third Party Liability requests, Out-of-pocket Maximum requests, EDI rejects and other special projects.
- Computer and 10-key skills by touch;
- Knowledge of medical terminology, CPT/RBRVS/ICD-10 codes;
- Full understanding of HMO & capitation concepts and Medicare guidelines;
- Extensive knowledge of facility, ancillary and professional claims
- Excellent communication skills
- Ability to work independently and function under time deadlines.
- Formal training will be indicated by a high school diploma or equivalent
- Minimum two (2) years medical claims processing experience
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V