Rancho Cordova, CA 95670
Rancho Cordova, CA
Our client is seeking the very best Claims Examiner. As a Claims Examiner, you ll be responsible for reviewing and adjudicating claims for services provided to members/patients enrolled through the company s clients in accordance with contract and industry standards. The Claims Examiner is an instrumental role in the department.
You re good at:
- Review claims for covered services as defined by contract and in accordance with the established guidelines for medical optometry claims using ICD-10 and CPT-4 classification systems
- Prepare correspondence for denied services and requests for additional information needed to support medical optometry claims submitted for processing
- Assist medical optometry claims supervisor with the ongoing training and development of department staff; manage data collection and reporting in support of time/service and quality assurance goals per industry standards, health plan contract and the organizational standards
- Collection of data in preparation for external client audits
- Resolution of escalated claims inquiries in a prompt, courteous, and professional manner
- Two or more years experience in medical optometry claims review/processing
- Knowledge of medical terminology, ICD-9 and CPT-4 coding and managed care claims administration
- High degree of computer proficiency with an emphasis placed upon Microsoft Office Products
- Knowledge of medical terminology & ICD-10 & CPT-4 codes and basic insurance principles
- You get paid WEEKLY! How cool is that?!
- You have access to benefits: medical, dental, and vision day one.
- You have a dedicated recruiter that cares about your success.
- You have access to dozens of jobs by applying to just one company.