Claims Examiner I
AltaMed Health Services
Date: 20 hours ago
City: Montebello, California
Contract type: Full time
Grow Healthy
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
A Claims Examiner is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Collaborates with other departments and/or providers in the successful resolution of claims-related issues.
Minimum Requirements
$25.00 - $29.32 hourly
Compensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
A Claims Examiner is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Collaborates with other departments and/or providers in the successful resolution of claims-related issues.
Minimum Requirements
- HS Diploma or GED.
- Must have some knowledge of Medi-Cal regulations.
- Must have some Knowledge of medical terminology.
- Must understand to read and interpret DOFRs and Contracts.
- Preferred knowledge of Medicare and Commercial rules and regulations.
- Must have an understanding of how to read a CMS-1500 and UB-04 form.
- Must have strong organizational and mathematical skills.
- Must be able to multi-task
$25.00 - $29.32 hourly
Compensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
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