Accounting - MedicalCompensation:
$33.25 to $38.50 per hour
A healthcare organization near Downtown Los Angeles is in need of a Claims Manager for a growing team. Education/Skill Requirements ? High School Diploma or general education degree (GED); Associate or Bachelor Degree in accounting, auditing, preferred. ? Minimum of 5-7 years of Medical, Vision and Dental Claims auditing ? Experience with Medicare and Medi-Cal/Medicaid reimbursement ? Strong analytical and investigative skills ? Proficient in healthcare claim adjudication standards and procedures ? Proficient in all healthcare coding (CPT4, HCPCS, DRG, ICD-9, ICD-10, Revenue Codes), certification in coding a plus. ? Ability to work independently and as part of a productive claims team ? Prior cost containment or claims analysis experience in a payer environment ? Requires working knowledge of provider billing guidelines, Medicare, Medi-Cal, and Medicaid reimbursement policies, medical necessity criteria, and applicable industry based standards. ? Understanding of the internal control and compliance risks assessments concepts and experience in applying them to plan, perform, manage, and report on the evaluation of various business processes/areas/functions. ? Ability to deal with complex claim issues. Preferred Knowledge of Medicaid Managed Care and Medicare Advantage regulatory guidelines preferred. ? Knowledge of Basic Managed Care principles preferred. ? Certified Coder credential a plus. If you are interested please submit your resume to: [Click Here to Email Your Resumé]
Medical Claims, CPT-4, Medicare, Medical Terminology
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$33.25 - $38.50 /Hour
Accounting, Finance, Professional Services