Claims Appeals Examiner

23 Apr 2024

Vacancy expired!

Duration: 18+ months contract

Job Description:· Examine returns and payments from multiple business entities to determine and make appropriate adjustments, such as approving or denying refunds and claims· Analyze and review claims based on claim types: long term care, inpatient, outpatient, or medical using CA-MMIS program· Calculate provider rate based on the provider rate master file and process adjustments as needed· Complete Claim Inquiry Forms to process provider appeals or claims· Respond to providers in written form by entering appropriate paragraph codes into the appeals sub-system and/or creating text to clarify the response· Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation

Responsibilities:· Maintain performance within defined qualitative and quantitative objectives· Review and resolve provider appeal within provider manual guidelines· Provide clerical support to management as needed· Ability to research the Provider Manual and policy set by the Department of Health Care Services· Completed Claim Inquiry Forms and Account Receivable to process the provider appeal or claim· Verify recipient eligibility and benefits, revenue, and ICD-9 codes· Ensure timeliness guidelines are met by reviewing the provider documentation

Experience:· 1-3 years’ experience preferred

Skills:· Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the job· Specific level of software skills as required by the work unit· Must have excellent problem-solving skills· Good verbal and written communication skills· Detailed oriented· Must be a proficient typist and have a minimum of 50 WPM while maintaining a 99.9% accuracy

Education:· High school education or equivalent

About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit ;/p>

  • ID: #49756090
  • State: California Sacramento 95811 Sacramento USA
  • City: Sacramento
  • Salary: Depends on Experience
  • Job type: Contract
  • Showed: 2023-04-23
  • Deadline: 2023-06-10
  • Category: Et cetera