Claims Adjudication Specialist

Orange, CA | Temporary

Job ID: [SA] Managed Care Claims Industry: Healthcare Pay Rate: $19.00

Do YOU have One (1) to three (3) years processing of managed care health claims? And have STRONG working knowledge of ICD.9.CM, CPT, HCPCS, RBRVS coding schemes and medical terminology? We are looking for YOU to aid in the success for the accurate and timely adjudication of claims in accordance with applicable contracts, state and federal regulations, health plan requirements.

The responsibilities and essential functions for the Claims Adjudication Specialist include the following:

Must demonstrate proficiency in the operation of the Company’s software and hardware systems for claims adjudication.

Have an excellent understanding of health and managed care concepts and their application in the adjudication of claims.

Must be able to accurately assess financial responsibility and liability for claims submitted.

Accurate input of data is required for claims adjudication.

The GOAL is to maintain 95 percent statistical/financial accuracy.

Take calls from Providers regarding claim status.

Knowledge of Division of Financial Responsibility(DOFR).

Ensure the privacy and security of PHI (Protected Health Information).

HIPAA Compliance.

Knowledge of Division of Financial Responsibility(DOFR)

Take calls from Providers regarding claim status.

Ensure the privacy and security of PHI(Protected Health Information) as outlined in department policies and procedures relating to HIPAA Compliance.

This is a long term contract with the opportunity for hire.

We offer employee incentive package

Medical benefits

Sick time


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