Claims Examiner
BC Forward

Job Info

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Claims Examiner
BCforward is seeking a highly motivated and experienced Claims Examiner at West Sacramento, CA 95605

Job Description:

• Examine returns and payments from multiple business entities to determine and make appropriate adjustments, such as approving or denying refunds and claims
• Analyze and review claims based on claim types: long term care, inpatient, outpatient, or medical using CA-MMIS program
• Calculate provider rate based on the provider rate master file and process adjustments as needed
• Complete Claim Inquiry Forms to process provider appeals or claims
• Respond to providers in written form by entering appropriate paragraph codes into the appeals sub-system and/or creating text to clarify the response
• Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation
• Maintain performance within defined qualitative and quantitative objectives
• Review and resolve provider appeal within provider manual guidelines
• Provide clerical support to management as needed
• Ability to research the Provider Manual and policy set by the Department of Health Care Services
• Completed Claim Inquiry Forms and Account Receivable to process the provider appeal or claim
• Verify recipient eligibility and benefits, revenue, and ICD-9 codes
• Ensure timeliness guidelines are met by reviewing the provider documentation

Knowledge and Skills:

• Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the job
• Specific level of software skills as required by the work unit
• Must have excellent problem-solving skills
• Good verbal and written communication skills
• Detailed oriented

Education and Experience Required:

• High school education or equivalent
• 1-3 years' experience preferred
• Must be a proficient typist and have a minimum of 50 WPM while maintaining a 99.9% accuracy

Location: West Sacramento, CA 95605
Expected Duration: 2 Years contract with strong possibility of extension
Wage: Hourly, W2

Who to Contact: Nick Johnson.

About BCforward
BCforward is currently the largest consulting and minority owned services and staffing firm in Indiana. Headquartered in Indianapolis, BCforward has resources in 47 states and Puerto Rico as well as a global presence in India and Canada. The company provides consulting, outsourcing and staff augmentation services in systems administration, project management, software development, and strategic IT planning. BCforward assures clients on-time delivery of on-budget solutions to their IT-centric outsourcing, staff augmentation and systems solutions needs. Formerly Bucher + Christian Consulting, the company was founded by Justin Christian in 1998. For more information, visit www.bcforward.com.

Interested candidates please send resume in Word format Please reference job code 175679 when responding to this ad.

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