Under close supervision, the Claims Examiner I will perform accurate review, entry and processing of all claims received for payment by HPSM.
Position overview

EDUCATION AND EXPERIENCE ARE EQUIVALENT TO:

• High School diploma, GED or equivalent required.
• Two (2) years’ general office experience. Claims processing experience preferred.

KNOWLEDGE OF:

• Medical billing and terminology.
• Medi-Cal and Medicare programs.
• Procedure and diagnostic coding.
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.

• Research rejected claims as necessary and re-adjudicated them when resolved.
• Claims entry of all standard claim forms.
• Correspond as required to resolve rejected claims.
• Review reports, verifying accurate data and making corrections as appropriate.
• Review fewer complex edits to determine the appropriate handling for each including paying, denying, or pending for Analyst II or III to review.
• Use Policies & Procedures, Claims Manual and other sources to complete the required number of weekly reviews required for this position.
• Assist in creation and development of memos, processes and tools when needed.
• Monitor own performance via production and auditing tools and reports.
• Attend team, company, and one-on-one meetings and other functions.
• Communicate issues with Manager and Claims Auditor; make recommendations on claims issues.