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Claims Rep II (Health and Dental)

Company: AppleOne
Location: Cerritos
Posted on: March 16, 2020

Job Description:

Knowledge with HIPPA or ICD 10 codes is required Medicare claims experience is needed as well People who already know how to process claims Understand and know how to read contracts There is a chance for extension of either extension Training schedule could vary based on hours are between 7AM and 5:30PM In person interviews

Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.). Must be able to successfully perform all the duties of the Claims Rep I. Primary duties may include, but are not limited to: Able to handle more complex claims. Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regs, coordination of benefits, & healthcare terminology. Good working knowledge of claims and products, including the grievance and/or re-consideration process. Excellent knowledge of the various operations of the organization, products, and services. Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement. Researches and analyzes claims issues. Responds to inquiries, may involve customer/client contact.?

Job Requirements:

Claims adjudication experience to a pay or deny status. Knowledge of Medicare/Medicare Dual products; Medicare/CMS regulatory compliance requirements. Claims processing experiences with professional, ancillary or facility claims.

Knowledge of Medicare claims processing

Requires a HS diploma or equivalent; 1-3 years of claims processing experience; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.); or any combination of education and experience, which would provide an equivalent background.

Keywords: AppleOne, Cerritos , Claims Rep II (Health and Dental), Healthcare , Cerritos, California

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