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Claims Processor

Company: The Judge Group
Location: La Mesa
Posted on: May 9, 2022

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!Contact:awine@judge.comThis job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, La Mesa , Claims Processor, Other , La Mesa, California

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