Claims Examiner 2-Managed Care

Claims Examiner 2-Managed Care Loma Linda University Health - 4.0 Redlands, CA Job Details Full-time $26.54 - $31.55 an hour 1 day ago Qualifications Computer operation Computer science Microsoft Excel Microsoft Outlook Medical claims processing Computer Science Managed care 5 years Computer literacy Bachelor's degree in business Equipment troubleshooting High school diploma or GED Certified Professional Coder

ICD-9 ICD-10

Driver's License Bachelor's degree Typing Senior level Business Bachelor's degree in computer science Medical terminology

DRG Full Job Description Department:

UHC:

Managed Care Job Summary:

This Claims Examiner 2-Mgd Care will process professional and hospital HMO Risk claims in accordance with the individual provider contracts in an accurate and timely manner, verify system assigned risk pool determination in accordance with HMO Division of Financial Responsibility matrix, initiate check run, perform standard reporting, ensure audit readiness, and process third party claims. Performs other duties as needed.

Education and Experience:

High School Diploma or GED required. Bachelor's Degree in Computer Science, Business, or similar degree preferred. Minimum five years managed care claims processing experience with professional claims and institutional claims.

Knowledge and Skills:

Knowledge of Microsoft Office Suite. Must be well versed in medical terminology, CPT, and ICD9/10 coding guidelines. Comprehensive understanding of institutional inpatient and outpatient hospital claims processing, DRG's and all other institutional calculation standards. Comprehensive understanding of professional claims adjudication process. Understanding of the Managed Care health care delivery system. Able to keyboard 40 wpm. Able to use a computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to work calmly and respond courteously when under pressure; collaborate and accept direction. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications:

Certified Professional Coder preferred. Valid Driver's License at time of hire.