Medicare Claims Representative Job

MEDICARE CLAIMS REPRESENTATIVE needed for a CONTRACT opportunity with Yoh's client located in San Francisco, CA.

TOP SKILLS SHOULD YOU POSSESS:

- Claims processing
- Working knowledge of Medicare

WHAT YOU'LL BE DOING:

- Process UB-04 facility and CMS-1500 professional claims for the full risk Medicare Advantage health plans
- Utilize Medicare PPS pricing tool to determine appropriate reimbursement
- Send letters to providers or members to request additional information as needed or to request overpayments
- Review, interpret and apply the correct Medical Service Referrals/Authorizations
- Process all types of medical claims with a thorough understanding of company claims adjudication policies and procedures (physician, hospital, vendor and ancillary providers) and the ability to manage EVR and pending reports

WHAT YOU NEED TO BRING TO THE TABLE:

- Minimum of four (4) years prior claims processing experience in an IPA, Hospital or Health Plan-related setting, with a focus on hospital facility claims processing and/or billing based on Medicare payment policies and methodology
- Knowledge of ICD 9/10 (International classification of diseases), CPT (Current Procedural Terminology) codes
- Recent experience with inpatient hospital claims and claims processing based on Medicare policies and payment methodology
- Thorough knowledge of medical terminology, enrollment and membership activities, and claims processing procedures/systems

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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