Medical Claims Processor
Description:
We are seeking a detail-oriented and efficient Medical Claims Processor to receive and adjudicate medical claims/bills for payment or denial. This role involves researching claims/bills for necessary supporting documentation, analyzing and adjusting data based on benefits criteria, and effectively responding to inquiries and resolving issues from vendors and members.
Location: 5971 Venice Blvd, Los Angeles, CA 90034
Hours: Monday - Friday, 8:30 AM - 5:00 PM
Contract Duration: 3-6 months with potential for extension and/or permanent placement.
Responsibilities:
- Receive and adjudicate medical claims/bills, researching necessary documentation.
- Analyze data and benefits criteria for accurate payment or denial of claims.
- Respond to and resolve vendor and member inquiries, questions, and complaints.
- Answer and screen departmental phone calls, routing messages appropriately.
- Greet patients/visitors, handle inquiries, and assist with required forms.
- Create accounts, transfer charges, and consolidate/correct duplicate accounts in internal systems.
- Schedule appointments (e.g., workers' compensation) and interact with internal/external parties for information.
- Maintain patient case notes, review subpoena requests, and complete transfer of care forms.
- Clear daily work queues and manage mail distribution and documentation.
- Perform general administrative tasks (typing, supply orders) and ensure excellent customer service.
Skills:
- 2+ yrs of experience processing medical claims/billing
- Minimum typing speed of 45 words per minute.
- Strong attention to detail and accuracy.
- Excellent communication and interpersonal skills.
- Ability to navigate and utilize computer systems effectively.
- Strong organizational and time management skills.
- Ability to problem-solve and handle customer inquiries professionally.
- Experience in a healthcare or medical claims processing environment is a plus.