Job Openings in Sacramento County and Beyond
Medical Claims Adjudicator
South Sacramento, CA | Temp-to-Hire Position
Responsibilities: Evaluates and processes claims in accordance with company policies and procedures according to productivity and quality standards. Determine coverage, complete eligibility verification, and identify discrepancies. Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, providerselection processes, claim coding. Interprets and processes routine and moderate complex claims. Check for erroneous items or codes and missing information and correct according to established procedures. Reviews and analyzes data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication. Alerts claims management to claims aging issues as well as provider billing problems.
Requirements: High School diploma or equivalent required. Familiar with ICD-9, HCPCS, CPT coding, modifiers, DMHC regulations, facility and professional claim billing practices. Two years or more years' experiencein managed care claims processing. Ability to maintain production level and quality goals. Excellent communication skills, including both oral and written. Excellent active listening and critical thinking skills