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Senior Claims Examiner

Company: Good Samaritan Hospital
Location: Whittier
Posted on: September 19, 2022

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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