CLAIMS EXAMINER - Memorial Health Services (tustin, CA)

CLAIMS EXAMINER Department: Claims Schedule: Full:Time Shift: Days Hours: 8:00AM:5:00PM Job Details: About us: Job Responsibilities: Sorts and reviews assigned claims in a timely and efficient manner. Understands eligibility, enrollment, referral and authorization issues. Keys claims efficiently. Maintains acceptable quality of at least 95 on reviewed claims. Meets production of 125 claims per day consistently. (Due to Chemotherapy claims being processed by 1 examiner) Correctly completes procedures for submitting claims to HMO??s for processing. Applies correct vendor contract rates to the processing of claims. Applies correct compliance date on claims, knowledgeable of all time frames for processing all claims. Maintains good working knowledge of system/internet and on line tools. Attends meetings and takes an active part in meetings. Qualifications/Skills: Experience: 2 or more years Claims Processing experience with professional and institutional claims, 2+ claims processing experience processing commercial and medicare advantage claims, 2+ years experience processing fee for service claims, 2+ years experience with processing electronic claims. Education: High school graduate or equivalent. Req Number: Source:

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