Claims Examiner III (Institutional/Hospital)
NAMM North America Medical Management - Ontario, CA

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Complete processing of hospital medical claims including adjudication and accuracy.

Responsibilities:
Accurately process institutional (hospital) claims.

Accurately process claims billed on UB04 Claim form.

Maintaining/meeting compliance time-frames.

Responsible for editing and adjudicating claims.

Analyze claims to ensure accurate billing and payment.

Interpret contracts and fee schedules.

Meet department accuracy and production standards.

Interface with other departments to obtain necessary information required for resolution of claims.

Qualifications:
UB Claim form

CPT, ICD-9 Volumes 1,2,3 and HCPCS coding

Revenue centers associated iwth billing

Hospital, ambulatory surgery center, home health, skilled nursing and dialysis claims

Division of Financial Responsibilities (DOFR)

Understanding of Stop Loss

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