Description
AppleOne is proud to present:
The Claims Examiner reports directly to the Claims Manager and is responsible for processing functions including operation, adjudication, and payment of UB-92 and HCFA-1500 claims received from PHP-affiliated medical groups and hospitals for HMO patients.
Required Qualifications:
Must have claims reimbursement experience
Must have DOFR (Division of Financial Responsibility) experience
Must have processed lab claims
2 years of claims adjudication experience in ambulatory, acute care hospital, HMO, or IPA environment
High school diploma or GED (must provide physical proof if background check cannot verify)
Knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
Understanding of timeliness and payment accuracy guidelines for commercial, senior, and Medi-Cal claims
Knowledge of compliance issues related to claims processing
Ability to interpret provider contract reimbursement terms
Ability to identify non-contracted providers for Letter of Agreement consideration
Data entry experience
Basic office automation and managed care computer systems training
Preferred Skills:
Experience interpreting provider contracts
Strong attention to detail and organizational skills
Additional Requirements:
References required for submission
Must be able to verify education and experience
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
#1031
Experienced (Non-Manager)