Processing of medical claims including verification, adjudication and accuracy.
- 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
- 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
North American Medical Management, California, Inc. (NAMM) develops and manages provider networks, offering a full range of services to...