Medical Claims Examiner

Medical Claims Examiner at Ultimate Staffing Services Medical Claims Examiner at Ultimate Staffing Services in Pasadena, California Posted in 8 days ago. $26.00 - $29.00 per hour

Job Description:

We are seeking an experienced Medical Claims Examiner to review, analyze, and adjudicate medical claims for accuracy, compliance, and medical necessity. The ideal candidate has strong working knowledge of ICD-9 and ICD-10 diagnosis coding and healthcare billing standards.

Key Responsibilities:

Review and process medical claims for completeness, accuracy, and compliance Apply ICD-9 and ICD-10 codes to evaluate claim validity Identify coding discrepancies, overpayments, and potential fraud or abuse Ensure claims adhere to payer policies, CMS guidelines, and regulatory requirements Document determinations and communicate findings as needed

Qualifications:

Proven experience as a Medical Claims Examiner or similar role Strong knowledge of ICD-9 and ICD-10 coding Familiarity with CPT, HCPCS, and medical billing guidelines Attention to detail and strong analytical skills Proficiency with claims processing systems and

MS Office Preferred:

CPC, CCS, or related certification Experience with Medicare, Medicaid, or commercial insurance claims All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.