Claims Examiner II

Work Boldly. Live Brilliantly.

At AltaMed, we don’t just serve our communities, we are part of them. We have raised the expectations of what a community clinic can deliver because we think quality care is for everyone. And, we are determined to provide it no matter the challenges because this is more than a job. It’s the calling of our lives and it compels us to keep moving forward.

Job Overview

A Claims Examiner is responsible for analyzing and the 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 Provider Dispute Resolution (PDR) process or from claims incident/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and Incidents. Collaborates with other departments and/or providers in successful resolution of claims related issues.

Minimum Requirements

• HS Diploma or GED
• 3+ years of Claims Processing experience in a managed care environment.
• Must be knowledgeable of Medi-cal regulations.
• Preferred knowledge of Medicare and Commercial rules and regulations.
• Knowledge of medical terminology.
• Must have an understanding to read and interpret DOFRs and Contracts.
• Must have an understanding how to read a CMS-1500 and UB-04 form.
• Must have strong organizational and mathematical skills.
  
  

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
  
  

Salary Range

$26.13 - $32.55 hourly