Claims Examiner
Company: Innovative Management Systems Incorporated
Location: Whittier
Posted on: June 23, 2022
Job Description:
Description:
The Position.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
claims.
- Troubleshooting and/or answering claims questions to
internal/external stakeholders.
- Adjudicating claims in the correct financial banks.
- Identifying dual coverage and potential third-party liability
claims.
- 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 decisions.The Specs.
- Full-Time.
- Benefits Eligible: Medical, Dental, Vision, Paid Time off, and
more.
- Non-exempt.
- Monday - Friday.
- Work-Life Balance.
- In-office / Hybrid.The Company. 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 protected classification.
Requirements:
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
software.
- Able to sit for long periods of time.
- Professional behavior, good business judgement and strong team
interaction skills.
- Valid Driver's License or able to reliably commute to the
office.
- U.S. Work Authorization (required.)PI182081930
Keywords: Innovative Management Systems Incorporated, Whittier , Claims Examiner, Other , Whittier, California
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