PIH Health CLAIMS EXAMINER (PIH HEALTH PHYSICIANS): FULL-TIME in Whittier, California

We’re a nonprofit, regional healthcare network with two hospitals, numerous outpatient medical offices, a multi-specialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer and emergency services. Our leadership is dedicated to putting patients first—a cornerstone of our mission, vision and values—as we deliver top-quality healthcare.

From our extensive facilities in Whittier, California and Downey, California, PIH Health serves more than two million residents in Los Angeles and Orange Counties and throughout the San Gabriel Valley.

THIS IS TO FILL A FULL-TIME POSITION WITH PIH HEALTH PHYSICIANS

The Claims Examiner is responsible for the processing of complex claims (stop loss, etc.) and adjudication and claims research when necessary. He/She must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers.

Required Skills

  • Experience processing all types of medical claims outpatient/inpatient UB-92 and HCFA-1500 claims as well as others
  • Dels effectively in a fast-paced, changing enviornment
  • Ability to work independently as well as be part of a team
  • Develops effective working relationships with all levels of the organization, including administration, doctors and staff
  • Must be familiar with computerized claims processing systems
  • Data entry and 10-key skills by touch and sight
  • Knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
  • Comprehensive medical terminology and knowledge
  • Efficiency and accuracy of claim payments during processing and adjudication.

Required Experience

  • High School Diploma or G.E.D. is required
  • Must have a minimum two (2) years of claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment.
  • Must have knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
  • Must have thorough understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims.
  • Experienced in interpreting provider contract reimbursement terms strongly preferred

Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V

Tracking Code: 4901-977

Job Location: Whittier, California, United States

Position Type: Full-Time/Regular

Shift Hours: 8am to 4pm