Senior Claims Examiner
Company: Good Samaritan Hospital
Location: Whittier
Posted on: September 19, 2022
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Job Description:
PIH Health is a nonprofit, regional healthcare network that
serves approximately 3 million residents in the Los Angeles County,
Orange County and San Gabriel Valley region. The fully integrated
network is comprised of PIH Health Hospital - Whittier, PIH Health
Hospital - Downey and PIH Health Good Samaritan Hospital, 27
outpatient medical locations, a multispecialty medical (physician)
group, home healthcare services and hospice care, as well as heart,
cancer, womens health, urgent care and emergency services. PIH
Health is certified as a Great Place to Work TM. For more
information, visit PIHHealth.org or follow us on Facebook, Twitter,
or Instagram.TheSenior ClaimsExaminer administers health plan
contracts by processing medical claims in an efficient,
cost-effective, and timely manner meeting all required guidelines
and performs adjustments as necessary. Some of the duties include
handling of Third Party Liability requests, Out-of-pocket Maximum
requests, EDI rejects and other special projects.Required
SkillsComputer and 10-key skills by touch;Knowledge of medical
terminology, CPT/RBRVS/ICD-10 codes;Full understanding of HMO &
capitation concepts and Medicare guidelines;Extensive knowledge of
facility, ancillary and professional claimsExcellent communication
skillsAbility to work independently and function under time
deadlines.Required ExperienceFormal training will be indicated by a
high school diploma or equivalentMinimum two (2) years medical
claims processing experienceBeyond the benefits that come with
working for the area's leading community healthcare provider one
that also recognizes the need to ensure patient safety and comfort
you'll enjoy an extremely competitive compensation and benefits
package. We are an equal opportunity employer and seek diversity in
our workforce. EOE M/F/D/V
Keywords: Good Samaritan Hospital, Whittier , Senior Claims Examiner, Other , Whittier, California
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