Claims Manager


  • Job ID:

    3419
  • Pay rate range:

    $14 - $25
  • City:

    San Diego
  • State:

    California
  • Duration:

    11/28/2021 - 02/28/2022
  • Job Type:

    Contract
  • Job Description

    Claims Processor 2 openings

    • $25 / HR
    • Start date 11/29
    • 3 months
    • San Diego, CA

    Opportunity Overview

    Healthcare system is currently seeking a claims processor for a 3 month contract opportunity in the San Diego area.

    Requirements for the Claims Processor

    Minimum 2 years of experience in Managed Care (HMO, Medicare, Covered California, Medi-Cal) with demonstrated performance that consistently exceeds expecations. Knowledge of CMS-1500, UB04 forms, CPT, HCPCS, ICD-9/ICD-10 codes and medical terminology for both electronic and paper claims.

    Responsibilities of the Claims Processor

    Reviews and processes 100-150 claims a day or 500/750 claims per week.  Verifies patient account, eligibility, benefits and authorization information; analyze the information to determine payment amount or denial of payment and appropriate member cost share as needed.  Utilizes coding software to determine if procedure codes billed are unbundled or payable by the Correct Coding Initiative guidelines.  Researches and applies appropriate payment/denial guidelines for benefits, coordination of benefits, "unclean" claims and member denials.  Identifies claims for edits based on contract and authorization specifics, DOFRs, newborn guidelines.  Makes appropriate edits and corrections to claims in the syste to ensure accurate and timely payment of claims. Generates member denial letters based on criteria given for claims that meet the financial responsibility of the member.  Assists with perpping, scanning and revewing paper claims to be uploaded to the processing system.

    #PCIT #health #healthcare #IT #internet #infoservices

    About PeopleCaddie

    PeopleCaddie is a digital talent marketplace focused exclusively on contract opportunities for highly-skilled business professionals. Our talent cloud utilizes proprietary data and technology to help contractors find attractive job opportunities through PeopleCaddie’s user-friendly mobile app while enjoying unparalleled visibility in pay rates and application status.

    With an established array of clients nationwide, including Fortune 500 companies spanning multiple industries, PeopleCaddie has quickly become one of the fastest-growing talent clouds.

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