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Claims Examiner II

Location: Lancaster
Posted on: May 23, 2023

Job Description:

High Desert Medical Group is seeking a full time Claims Examiner II for our Claims department. This individual will be responsible for reviewing and adjudicating adjustments and provider disputes adjustments accurately and according to regulatory guidelines. They will be expected to maintain a professional, positive, and caring attitude at all times.Summary of Duties:Adjudicates professional claims according to CMS policy and guidelines, CPT, and departmental guidelines; minimum of 120 claims per day with less than 5% error rate.Handles patient and vendor claims inquiries and problem issues.Reviews and research pending claims via claim reports.Adjust claims that have been erroneously adjudicated initially or any claims where additional information has been submitted.Review and adjudicates adjustments and provider disputes adjustments accurately and according to regulatory guidelines.Maintains regulatory timeliness for claims adjudicated.Follow and adhere to the company attendance policy, as it is critical to log and maintain accuracy on claims on a daily basis.Performs other duties as assigned.The pay range for this position at commencement of employment is expected to be between $37,440.00 and $49,920.00/year, non-exempt; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participationin these benefit plans will be provided if an employee receives an offer of employment.If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.Requirements:High School diploma or equivalent.Minimum one year experience in a medical group.Courses in bookkeeping, accounting, insurance billing, and data processing, desirable.Computer literate with technical and ten key skills.Knowledge in EZ-Cap software desirable.Knowledge of medical terminology, ICD-10 coding and HCPCS coding.Excellent written and verbal communication skills.Ability to handle and prioritize tasks in order to meet all given deadlines and productivity goals.Ability to responsibly handle matters of a confidential nature.Ability to work in a multi-task, high-productive environment.

Keywords: HIGH DESERT MEDICAL CORP, A MEDICAL GRP, Lancaster , Claims Examiner II, Other , Lancaster, California

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