Claims Examiner Job

CLAIMS EXAMINER II needed for a CONTRACT opportunity with Yoh's client located in Richmond, CA.

Top Skills Should You Possess:
- Claims processing experience
- Proficiency in ICD-9 and CPT

What You'll Be Doing:
- Perform quality and production performance benchmarks, research/review necessary documentation and apply claims policies appropriately and accurately in order to review
- Adjudicate and finalize electronic and/or paper medical claims ensuring accordance with departmental guidelines as well as state, federal and health plan regulatory requirements

What You Need to Bring to the Table:
- High school diploma
- Three (3) years of claims processing experience in an IPA or HMO related setting
- Experience and proficiency in ICD-9, CPT and HCPC coding systems
- Thorough knowledge of medical terminology, enrollment and membership activities and claims processing procedures/systems
- Ability to process all types of medical claims and interpret authorizations, contracts and physician reimbursement methodologies
- Experience deciphering DOFR (Division of Financial Responsibility)

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Andersen

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Contact us if you are an individual with a disability and require accommodation in the application process.

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