Plans examiner Jobs in Fresno, CA
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Plans examiner • fresno ca
Last updated: 30+ days ago
Orange, CA is a premier healthcare provider specializing in Medicare and HMO services.With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize acc...Show moreLast updated: 30+ days ago
Transitional Senior Claims Examiner.This specialized, full-time role is designed for seasoned professionals who can step in to manage open desks or oversee pending claims during an adjuster's leave...Show moreLast updated: 30+ days ago
- Promoted
Claims Examiner I
Astiva Health, IncFresno, CA, USFull-time
- Promoted
Senior Claims Examiner I
AmTrust FinancialFresno, CA, United StatesFull-time
The average salary range is between $ 61,182 and $ 71,868 year , with the average salary hovering around $ 66,525 year .
- hospitalist (from $ 31,000 to $ 250,000 year)
- owner operator (from $ 52,000 to $ 239,433 year)
- physician (from $ 100,000 to $ 234,000 year)
- medical field (from $ 52,500 to $ 223,800 year)
- construction management (from $ 90,000 to $ 220,000 year)
- software architect (from $ 150,000 to $ 217,500 year)
- nurse practitioners (from $ 129,250 to $ 215,500 year)
- dentist (from $ 31,200 to $ 214,800 year)
- technical director (from $ 35,724 to $ 213,895 year)
- general dentist (from $ 39,000 to $ 209,750 year)
- Ventura, CA (from $ 89,525 to $ 258,303 year)
- Everett, WA (from $ 87,575 to $ 180,905 year)
- Boulder, CO (from $ 68,250 to $ 150,000 year)
- Miami, FL (from $ 67,985 to $ 135,745 year)
- Santa Ana, CA (from $ 67,824 to $ 130,481 year)
- Santa Clarita, CA (from $ 67,824 to $ 130,481 year)
- Santa Clara, CA (from $ 67,824 to $ 130,481 year)
- Santa Rosa, CA (from $ 67,816 to $ 128,364 year)
- Sacramento, CA (from $ 20,800 to $ 124,800 year)
- Fremont, CA (from $ 120,448 to $ 124,585 year)
The average salary range is between $ 56,179 and $ 91,645 year , with the average salary hovering around $ 68,731 year .
Claims Examiner I
Astiva Health, IncFresno, CA, US30+ days ago
Job type
- Full-time
Job descriptionGood knowledge of CPT / HCPCS / ICD-10, and Revenue Codes, including modifiers. Assist customer service as needed to assist in claims resolution on calls from providers. Research authorizations and properly selects appropriate authorization for services billed. Coordinate with the claims clerks on issues related to the submission and forwarding of claims determined to be financial responsibility of another organization. Coordinate Benefits on claims for which member has another primary coverage Run monthly reports. Review pre and post check run. Regular and consistent attendance Other duties as assigned High School Diploma or GED required. 1 to 3 years of previous experience in a health plan, IPA or medical group. Strong understanding of the benefit process including member services or customer service. Demonstrated proficiency in MS Office (Excel, Word, Outlook, and PowerPoint). Able to navigate difficult situations with empathy, discretion, and professionalism. Strong understanding of Senior Medicare Advantage Health plans. Able to explain member benefits, answer questions and concerns using a "Customer Service First" attitude. Able to live our mission, vision, and values, Bilingual in another language (written and oral) preferred.
About Us : Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.
SUMMARY : Under the direction of the Vice President of Claims, this position is responsible for manual input and adjudication of claims submitted to the health plan. The ideal candidate will need to interpret and utilize capitation contracts, payor matrixes, subscriber benefit plan, and provider contracts; as well as resolving customer service inquiries, status calls, andclaim tracers.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following :
- Data enter paper claims into EZCAP.
- Review and interpret provider contracts to properly adjudicate claims.
- Review and interpret Division of Financial Responsibility (DOFR) for claims processing.
- Perform delegated duties in a timely and efficient manner.
- Verify eligibility and benefits as necessary to properly apply co-pays.
- Understands eligibility, enrollment, and authorization process.
- Knowledge of prompt payment guidelines for clean and unclean claims
- Process claims efficiently and maintains acceptable quality of at least 95% on reviewed claims.
- Meets daily production standards set for the department.
- Prepares claims for medical review and signature review per processing guidelines.
- Identify the correctly received date on claims, with knowledge of all time frames for meeting compliance for all lines of business.
Maintains good working knowledge of system / internet and online tools used to process claims
QUALIFICATION REQUIREMENTS : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and / or EXPERIENCE :