Managed Care Claims Examiner Job

MANAGED CARE CLAIMS EXAMINER needed for a Contract opportunity with Yoh's client located in Los Angeles, CA.

THE BIG PICTURE - TOP SKILLS YOU SHOULD POSSESS:

- Claims Examiner Level III in a Managed Care Setting
- Must have Medi-Cal claims processing experience
- Must have previous experience in EDI Claims processing.

WHAT YOU'LL BE DOING:

- Processing claims for all lines of business in a Health Plan, including complex claims
- Monitoring billings for excessive charges, duplications, unbundling, and medical coding
- Requesting and reviewing medical records as needed for basic information to validate billing information

WHAT YOU NEED TO BRING TO THE TABLE:

- Associates Degree in Healthcare Related Field
- Three to five (3 - 5) years of Claims Examiner Level III experience in a Health Plan Setting
- Must have two to five (2 - 5) years of EDI Claims and Medi-Cal Experience
- Must have Medical Terminology experience
- Proficient in Microsoft Word and Excel
- Must have knowledge of State Department of Health Services regulations

BONUS POINTS! PREFERRED QUALIFICATIONS:

- Bachelors Degree
- Certification in Coding
- Bilingual in Either Spanish or Chinese

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Christine Torres

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

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