Lead Claims Examiner

Lead Claims Examiner

The Lead Claims Examiner of Check Runs and Special Projects is responsible for ensuring that all check runs are performed in a timely manner ensuring compliance and use of designated parameters by Leadership. The Lead Claims Examiner of Check Runs and Special Projects will also assist by processing medical claims in an efficient, cost-effective, and timely manner meeting all required guidelines and performs adjustments as necessary. In addition, she will serve as back up to the other Leads in the department and will report to the Director of Claims.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience.

Required Skills

• Working knowledge of claims regulatory timeframes / timeliness of payment.
• Working knowledge of medical terminology & RVS / CPT / RBRVS / ICD-9 codes
• Experienced with provider contract payment methodologies including but not limited to case-rates and stop-loss.
• Experience in EZCAP check run process.
• Excellent communication, problem solving, and decision-making skills coupled with the ability to work successfully in a team environment.
• Leads the Claims Department in conducting regularly scheduled check runs.

Required Experience

Minimum Salary

$21.50

Maximum Salary

$35.46