Claims Auditor / Claims ProcessorPacer Group • Whittier, CA, US
No longer accepting applications
Claims Auditor / Claims Processor
Pacer Group • Whittier, CA, US
30+ days ago
Job type
- Full-time
Job descriptionEnsure confidentiality of patient protected health information (HIPAA compliant) Assist the Claims Director with training and education of Claims staff Coordinate, generate, and review claims audits, pending claims, and status reports Investigate and process payment adjustments (refunds, overpayments, underpayments) Serve as a professional resource for providers, members, insurance carriers, and staff Research and respond to claims-related inquiries in a timely manner Create and maintain system-generated reports Support compliance with legal, regulatory, and contractual audit requirements Prepare and present weekly and monthly quality and performance reports Review and audit member liability denials and Provider Dispute Resolution claims Perform additional duties as assigned
Job Description
Job Title : Claims Auditor / Claims Processor
Location : Whittier, CA
Start Date : (Immediate Start)
Duration : 13 weeks
Schedule Shift : Days | 7 : 00 AM – 3 : 30 PM | 8-hour days | 40-hour guarantee
Pay Rate : $30 / hour
Description
TITLE : Claims Auditor / Claims Processor
PIH Health Physicians is seeking an experienced Claims Auditor / Claims Processor to support the Claims Department. This role is ideal for professionals with strong medical claims processing experience and knowledge of HMO / IPA operations, Medicare, and Medi-Cal guidelines.
EDUCATION / EXPERIENCE / TRAINING
Required
- High School Diploma or equivalent
- Minimum 4 years of medical claims processing experience
- Knowledge of :
- HMO and / or IPA operations
- Medical terminology
- ICD-10, CPT, RVS coding
- Medicare & Medi-Cal guidelines
- Strong 10-key skills (by touch)
- Excellent organizational, communication, and time-management skills
- Ability to meet deadlines in a fast-paced environment
DUTIES AND RESPONSIBILITIES
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Claims Auditor Claims Processor • Whittier, CA, US
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