Robert Half Corporation Jobs

Job Information

Robert Half International Medical Claims Examiner in Encino, California

Description A well know Medical Network is in need of a Claims Examiner for their location in Encino. As the Claims Examiner you will be responsible for accurately and consistently adjudicating claims in accordance with policies, procedures and guidelines as outlined by the company policy. Processes claims according to all CMS and DMHC guidelines. Investigate and complete open or pended claims. Meet production and quality standards.

ESSENTIAL JOB DUTIES:

• Meets productivity standards for number claims completed and for accuracy of entries • Handles in a detail oriented and confidential manner all correspondence • Receives, and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information. • Receives daily workflow via reports or work queue and incoming phone calls • Researches claims for appropriate support documents • Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied • Responds and documents resolution of inquiries from internal departments • Assists Finance with researching provider information to resolve outstanding or stale dated check issues • Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases

KNOWLEDGE, SKILLS AND EXPERIENCE: 3+ years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting. Knowledge of general claims processing principles. Knowledge of CMS and UB coding. Experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims. Experience on an automated claims processing system (Epic Tapestry preferred) Requirements KNOWLEDGE, SKILLS AND EXPERIENCE: 3+ years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting. Knowledge of general claims processing principles. Knowledge of CMS and UB coding. Experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims. Experience on an automated claims processing system (Epic Tapestry preferred)

Accountemps, a Robert Half Company, matches skilled accounting and finance professionals with remote or on-site jobs on a temporary and temporary-to-hire basis. Our experienced staffing professionals can promote you to employers and advocate on your behalf. We provide access to top jobs, competitive compensation and benefits, and free online training. For more opportunities, get the Robert Half app and receive instant notifications when our AI matches your skills and experience with jobs.

When you work with us, you’re working with the best. Robert Half has been recognized as one of FORTUNE’s “Most Admired Companies” every year since 1998 and was named to Forbes’ inaugural list of America’s Best Temporary Staffing Firms.

Questions? Call your local office at 1.888.490.3195. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to temporary professionals. Visit https://roberthalf.gobenefits.net/ for more information.

© 2020 Accountemps. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (www.roberthalf.com/terms-of-use).

DirectEmployers