Partnership HealthPlan of California · 2 hours ago
Claims Examiner I
Sonoma County, CA
Full-time
Onsite
New Grad, Entry Level
$28.94/hr - $34/hrPartnership HealthPlan of California is seeking a Claims Examiner I to review, research, and resolve claims for all Medi-Cal claim types. The role involves creating documentation, generating provider communication, and tracking claims requiring review by other staff and departments.
Health CareInsuranceNon Profit
Responsibilities
Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report
Routes claims to appropriate PHC departments and internal staff for additional review. Follows up and completes claims once response to request has been received
Follows established PHC policies and procedures, PHC Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims
Generates claims correspondence as needed
Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor
Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame
Supports Claims Department’s needs for resolving all pended claim types
Participates in special projects and assignments as required
Other duties as assigned
Qualification
Required
High school diploma or equivalent
Prior experience examining claims in an automated environment
Effective written and oral communication skills
Good organization skills
Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy
Ability to stay focused on repetitive work and meet production and quality standards
Ability to accurately complete tasks within established timelines
Ability to use a computer keyboard
Ability to move, carry, or lift objects of varying size, weighing up to 5 lbs
Company
Partnership HealthPlan of California
Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the state to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care.
Founded in 1994
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
L
Lorna Veloso
Sr. Manager of OpEx/PMO
Recent News
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