Claims Examiner in Ontario, CA at PRIME HEALTHCARE SERVICES ONTARIO

Date Posted: 4/11/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    3300 East Guasti Road
    Ontario, CA
  • Job Type:
    Other
  • Experience:
    Not Specified
  • Date Posted:
    4/11/2018

Job Description

The Claims Examiner is responsible for evaluation of billing, coding and supporting documentation of physicians, facilities and ancillary providers. Communicates clearly and efficiently by phone, in person and email with the TPA claims administrator and other inhouse staff members. This position is expected to have knowledge of and stay current with ERISA and state regulation standards and reports irregularities with billing, claims, documentation, etc. Reviews and reports on physician coding and reports to Manager to initiate corrective action plans as necessary. Available for all Benefits staff for coding, regulation and documentation review. Maintains all necessary information needed to comply with insurance billing requirements. Is certified AHIMA, CPC or equivalent.