Claim Examiner II
NAMM North America Medical Management - Ontario, CA

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Processing of medical claims including verification, adjudication and accuracy.

Responsibilities:
- Accurately process professional claims

- responsible for editing and adjusting of claims per the EDI daily audit report

- analyze and adjudicate claims to ensure accurate payment

- interpret Fee for Service (FFS) and capitated provider contracts

- meet department quality and accuracy standards

- interfaces with other departments to obtain necessary information required for claim resolution

- advise management of any claim issues or inappropriate and/or incorrect billing

- other duties assigned by management

Qualifications:
- must have 2-3 years experience as a Medical Claims Examiner

- 1-2 years experience of professional claims processing preferred

- prior Medicare, HMO experience preferred

NAMM North America Medical Management - 6 months ago - save job - block
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