insurance claims processor in ontario

posted
job type
temporary
salary
US$ 21 per hour
apply now

job details

posted
location
ontario, california
job category
Administrative & Support Services
job type
temporary
salary
US$ 21 per hour
reference number
S_662186
apply now

job description

Duration: 07/16/2018 to 10/15/2018 (Temp to Hire)
Hours: M-F 7:30am-4:30pm
Pay: $21.00/hr

Responsibilities:
Specific Duties:
1.Reviews written dispute requests received from providers of denied or incorrect payments based on contractual arrangements with providers and non-contractual providers. Regarding either Professional or Institutional Claims.
2. Ability to interpret provider and health plan contracts to ensure accurate payment of claims or denial of services based on the terms of the provider contract and the financial responsibility as set in the health plan contract. Including RBRVS and Medicare guidelines as it applies to contracted and non-contracted providers.
3.Adjust claims, as appropriate, including calculation of interest and penalties due when applicable.
4.Ability to identify potential issues related to system configuration, benefits, eligibility, authorizations, etc. affecting the Claims Departments ability to process claims accurately and forwarding those issues to the correct internal department, attaching all necessary documentation, to ensure the system is updated, as appropriate and follow-up with these departments.
5.Plan and organize workload to ensure efficient and compliance resolution of issues.
6.Communicate to Provider in writing, for all disputes utilizing system formatted letters in a clear and concise manner in accordance with all guidelines set by the department
7. Responsible for requesting special check run requests to insure compliance
8.Warning reports are monitored daily to insure compliance
9. Provider education calls completed based on outcomes of PDR
10. Responsible for documenting each dispute in Provider Dispute Database accurately for reporting purposes for management reports to all customers internally and externally as required by AB1455.

Working hours: 7:30 AM - 4:30 PM

Skills:
Must have qualifications/experience:
1.High school diploma or a general education degree.
2.Minimum of three to five years' experience as a Claims Examiner with previous Medicare and HMO experience.
3.Previous auditing and appeals experience preferred
4. Working knowledge of medical terminology, ICD9, ICD 10, CPT4, HCPCs
5. Working knowledge of UB04 and CMS 1500 Forms
6. Ability to effectively interpret provider contract language and provisions
7. Extensive HMO knowledge
8. Familiar with AB1455, Knox Keene Act, Federal Register and Medicare Guidelines and Regulations
9. Ability to communicate effectively
10. Excellent grammatical and letter writing skills; in adherence to regulatory guidelines
11. Excellent analytic skills needed.
12. Must be flexible, self starter, team player
13. Ability to stringently manage, decipher and adhere to Regulatory timeframes for PDR and CMS Dispute processing.
14. Working knowledge of Revenue and HCPCS coding practices
15. Must be able to work independently and solve moderately complex issues with limited supervision.

Qualifications:
Please send resume to janelle.forystek@randstadusa.com

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad. EEO Employer: Race, Religion, Color, National Origin, Citizenship, Sex, Sexual Orientation, Gender Identity, Age, Disability, Ancestry, Veteran Status, Genetic Information, Service in the Uniformed Services or any other classification protected by law. San Francisco Fair Chance Ordinance: Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

skills

Must have qualifications/experience: 1.High school diploma or a general education degree. 2.Minimum of three to five years' experience as a Claims Examiner with previous Medicare and HMO experience. 3.Previous auditing and appeals experience preferred 4. Working knowledge of medical terminology, ICD9, ICD 10, CPT4, HCPCs 5. Working knowledge of UB04 and CMS 1500 Forms 6. Ability to effectively interpret provider contract language and provisions 7. Extensive HMO knowledge 8. Familiar with AB1455, Knox Keene Act, Federal Register and Medicare Guidelines and Regulations 9. Ability to communicate effectively 10. Excellent grammatical and letter writing skills; in adherence to regulatory guidelines 11. Excellent analytic skills needed. 12. Must be flexible, self starter, team player 13. Ability to stringently manage, decipher and adhere to Regulatory timeframes for PDR and CMS Dispute processing. 14. Working knowledge of Revenue and HCPCS coding practices 15. Must be able to work independently and solve moderately complex issues with limited supervision.

qualification

Please send resume to janelle.forystek@randstadusa.com

responsibilities

Specific Duties: 1.Reviews written dispute requests received from providers of denied or incorrect payments based on contractual arrangements with providers and non-contractual providers. Regarding either Professional or Institutional Claims. 2. Ability to interpret provider and health plan contracts to ensure accurate payment of claims or denial of services based on the terms of the provider contract and the financial responsibility as set in the health plan contract. Including RBRVS and Medicare guidelines as it applies to contracted and non-contracted providers. 3.Adjust claims, as appropriate, including calculation of interest and penalties due when applicable. 4.Ability to identify potential issues related to system configuration, benefits, eligibility, authorizations, etc. affecting the Claims Departments ability to process claims accurately and forwarding those issues to the correct internal department, attaching all necessary documentation, to ensure the system is updated, as appropriate and follow-up with these departments. 5.Plan and organize workload to ensure efficient and compliance resolution of issues. 6.Communicate to Provider in writing, for all disputes utilizing system formatted letters in a clear and concise manner in accordance with all guidelines set by the department 7. Responsible for requesting special check run requests to insure compliance 8.Warning reports are monitored daily to insure compliance 9. Provider education calls completed based on outcomes of PDR 10. Responsible for documenting each dispute in Provider Dispute Database accurately for reporting purposes for management reports to all customers internally and externally as required by AB1455.

educational requirements

High School