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Claims Examiner

Company: Impresiv Health
Location: Santa Barbara
Posted on: November 27, 2022

Job Description:

Job Description

Title: Claims Examiner

Duration: 6 months

Description: Under the direct supervision of the Claims Supervisor, this position is responsible for: researching, correcting, and responding to all pended claims as well the review of Audit reports in a timely manner; determining whether a claim should be paid (in accordance with the policies and procedures) and maintaining correspondence for document procedure /medical/CPT/ HCFA codes; assuring all regulatory guidelines are being followed.

What You Will Do:

  • Review, price and release claims associated with the assigned claim types (paper and electronic)
  • Review Manual Review reports that suspend for review on all CenCal Health programs
  • Review audit reports for all CenCal Health programs
  • Analyze current processes and work with Supervisor to automate or improve quality where fit
  • Assist with ideas for creation of SCF (System Change Forms) when applicable
  • Keep up to date on all CenCal Health policies and provide materials for improvement projects within Department
  • Assure all regulatory guidelines are being followed and monitored
  • Maintain daily activity log
  • Assist with the processing of claims
  • Audit and report all billing & error trends found during the course of review and data entry;
  • Maintain processes and timelines required by AB1455 Claims Settlement Practices and DHCS Regulations
  • Other duties and projects as assigned

    You Will Be Successful If:

    • Knowledge of the Medi-Cal program
    • Prior experience in high volume production environment
    • Good oral and written communication skills
    • Attention to detail
    • Medical terminology and/or coding experience is highly desirable

      What You Will Bring:

      • High school diploma or equivalent
      • Experience as a claims examiner
      • Previous experience with Mei-Cal '
      • Previous coding experience preferred

        About Impresiv Health:

        Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

        Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate About Impresiv Healthvalue, at a rate that cannot be beaten. Your success matters, and we know it.

        That's Impresiv!

Keywords: Impresiv Health, Santa Barbara , Claims Examiner, Other , Santa Barbara, California

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