Company: Innovative Management Systems Incorporated
Posted on: June 15, 2022
We are looking for a detail-oriented individual that can accurately
review, research, and analyze professional claims to determine and
calculate the type and level of benefits based on established
criteria and provider contracts. Experience in adjudication of
Commercial, Medicare Advantage, and Medi-Cal claims will make you a
great candidate, along with experience or familiarity with
Healthcare Service industry, Independent Physician Associates
(IPAs), and/or have experience in a Managed Care/Service
Organization (MSO) or Health Plan background.
Some duties include:
identifying authorizations and matching authorization to
Troubleshooting and/or answering claims questions to
Adjudicating claims in the correct financial banks.
Identifying dual coverage and potential third-party liability
Coordination of Benefits to management for approval and updating
system insurance coverage profile.
Understanding and interpreting health plan Division of Financial
Responsibilities and contract verbiage.
Supporting the Claims Departments and other Examiners and
troubleshoots Claims issues for internal/external stakeholders.
Documenting resolution of claims to support claim payment and/or
Benefits Eligible: Medical, Dental, Vision, Paid Time off, and
Monday - Friday.
In-office / Hybrid.
Our team at IMS is looking for highly motivated individuals to join
our growing start-up. We strive to innovate the healthcare industry
by providing management and consultant services to Independent
Physicians Associations (IPAs) and Health Plans. Our team utilizes
their comprehensive knowledge of the healthcare industry to provide
quality services for our contracted Medicare members in a
fast-paced and multi-faceted environment. Our positions offer an
in-depth perspective of the managed care industry to interested
candidates that are looking to take risks and share in professional
development and growth alongside our expanding company. If you are
looking to make an impact in your career, in a flourishing new
company, and in the healthcare industry, we welcome you to apply to
join our team!
Innovative Management Systems is an equal opportunity employer. We
celebrate teamwork, diversity, and inclusivity by creating a work
environment where everyone respects each other, regardless of race,
color, religion, sex, gender identity, sexual orientation,
pregnancy, age, national origin, physical or mental disability,
military or veteran status, genetic information, or any other
What You Need.
High School Diploma and/or equivalent work experience in managed
care/services, health plan, and/or IPA.
Minimum of 1 year of related claims processing experience in
managed care/services, health plan, and/or IPA (preferred).
Knowledge of HCFA 1500 forms, CPT, and ICD codes (required).
Strong understanding of division of financial responsibility for
determination of financial risk.
Practical knowledge and understanding of relevant business
practices and applicable regulations/policies.
Excellent written and verbal communication.
Strong contract verbiage and knowledge of claims processing
Able to sit for long periods of time.
Professional behavior, good business judgement and strong team
Valid Driver's License or able to reliably commute to the
U.S. Work Authorization (required.)
Keywords: Innovative Management Systems Incorporated, Whittier , Claims Examiner, Other , Whittier, California
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