Christmas Lumber Company, Inc.
Provider Dispute Resolution Claims Examiner
Christmas Lumber Company, Inc., Los Angeles, California, United States, 90079
Position Description
The Provider Dispute Resolution Claims Examiner is responsible for:– The accurate analysis and resolution determination of Provider Disputes from all sources.– Assist in the resolution of eligibility, benefit, contracting, and payment schedule issues.– Handle and document resolution to escalated telephone and written appeals.– Ensuring all PDR documents are processed timely with timely submission of all acknowledgement and resolution letters– Timely processing of complex PDR claims for all lines of business– Auditing claims for excessive charges, duplicates, unbundling, and medical up coding– Maintaining department databases used for report production and tracking on-going work– Assisting management with in-house and on-site training as offered to employees and providers.Experience Required
– At least 1-2 years of healthcare claims processing experience in a managed care environment with at least one year working with provider disputes.– Experience processing PDR documents– Previous Medi-Cal or Medicare claims processing experience and knowledge of AB1455 regulations.– Ability to self-manage in a fast-paced, detail-oriented environment.– Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials(PDR, CPT, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge.– Moderate knowledge of Microsoft Word and Excel.Education Required
Associate’s DegreeApply Now
Please send your resume and any additional information to our recruitment team at recruitment@teknita.com
#J-18808-Ljbffr
The Provider Dispute Resolution Claims Examiner is responsible for:– The accurate analysis and resolution determination of Provider Disputes from all sources.– Assist in the resolution of eligibility, benefit, contracting, and payment schedule issues.– Handle and document resolution to escalated telephone and written appeals.– Ensuring all PDR documents are processed timely with timely submission of all acknowledgement and resolution letters– Timely processing of complex PDR claims for all lines of business– Auditing claims for excessive charges, duplicates, unbundling, and medical up coding– Maintaining department databases used for report production and tracking on-going work– Assisting management with in-house and on-site training as offered to employees and providers.Experience Required
– At least 1-2 years of healthcare claims processing experience in a managed care environment with at least one year working with provider disputes.– Experience processing PDR documents– Previous Medi-Cal or Medicare claims processing experience and knowledge of AB1455 regulations.– Ability to self-manage in a fast-paced, detail-oriented environment.– Extensive knowledge of medical terminology, standard claims forms and physician billing coding, ability to read/interpret contracts, standard reference materials(PDR, CPT, ICD-10, and HCPCS), and complete product and Coordination Of Benefits (COB) knowledge.– Moderate knowledge of Microsoft Word and Excel.Education Required
Associate’s DegreeApply Now
Please send your resume and any additional information to our recruitment team at recruitment@teknita.com
#J-18808-Ljbffr