Claims Processor
Company: The Judge Group
Location: La Mesa
Posted on: May 9, 2022
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Job Description:
Location: La Mesa, CADescription: Our client is currently
seeking a Claims Processor in La Mesa, CA!This job will have the
following responsibilities:Reviews and processes 100-150 claims a
day or 500/750 claims per week. Verifies patient account,
eligibility, benefits and authorization information; analyze the
information to determine payment amount or denial of payment and
appropriate member cost share as needed. Utilizes coding software
to determine if procedure codes billed are unbundled or payable by
the Correct Coding Initiative guidelines. Researches and applies
appropriate payment/denial guidelines for benefits, coordination of
benefits, "unclean" claims and member denials. Identifies claims
for edits based on contract and authorization specifics, DOFRs,
newborn guidelines. Makes appropriate edits and corrections to
claims in the system to ensure accurate and timely payment of
claims. Generates member denial letters based on criteria given for
claims that meet the financial responsibility of the member.
Assists with prepping, scanning and reviewing paper claims to be
uploaded to the processing system.Qualifications &
Requirements:Minimum 2 years of experience in Managed Care (HMO,
Medicare, Covered California, Medi-Cal) with demonstrated
performance that consistently exceeds expectations. Knowledge of
CMS-1500, UB04 forms, CPT, HCPCS, ICD-9/ICD-10 codes and medical
terminology for both electronic and paper claims.If you, or someone
you know, are both qualified and interested in this position,
please send an up to date resume to Ashley at
awine@judge.com!Contact:awine@judge.comThis job and many more are
available through The Judge Group. Find us on the web at
www.judge.com
Keywords: The Judge Group, La Mesa , Claims Processor, Other , La Mesa, California
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