Claims Examiner (In office; remote option WFH, equipment not provided)

A people-centric culture that values collaboration and work-life balance. If you are enthusiastic about helping those in need, then your enthusiasm is welcomed here.

To Apply see attached link.

https://insperity.avature.net/en_US/careers/JobDetails?jobId=21634

The Claims Examiner is primarily responsible for the accurate and timely adjudication of paper and / or electronically formatted claims received in the CMS 1500 and / or UB-04 format. The Claims Examiner processes all claims in accordance with Medicare and Medi-Cal regulatory guidelines.

Skill & Experience Requirements:

• Minimum of 4 years medical claims payment experience in an HMO environment (i.e. MSO, IPA or health plan)
• Strong knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines.
• Experience with CPT-4, ICD-10CM, RBRVS, ASA and HCPCS as well as in depth understanding of Medicare and Medi-Cal guidelines that apply to COB and Medicare Secondary Payer.
• Extensive familiarity and experience in planning benefit and co-payment determination, division of financial responsibility determination, claims policies and procedures and adjudication processes and claim review and analysis involving NCCI rules.

Extensive working knowledge of reimbursement methodologies of professional claims including injectable drugs.

Note: Qualified applicants with arrest or conviction records will be considered for employment with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Thrifty Management Services is the dedicated MSO for Preferred IPA of California, providing the best possible care management, care coordination, and claims processing services to Preferred IPA and their members. We work with the network’s participating physicians to coordinate patient care when a referral is made to a specialist or hospital for diagnosis and treatment. We coordinate patient care across all aspects of the provider network. We provide high quality services to its participating physicians and superior health care to its members.

Job Type: Full-time

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: In person