claims adjuster Downey, CA
Kaiser Permanente
Full Time
Downey, CA
36.87019230769231 - 33.27980769230769 USD HOURLY Today
Job description
Reviews claims and makes payment and benefit determination. Conducts research as it relates to claims processing for medical appropriateness, and diagnosis, using ICD-9 codes and CPT codes as required.
Essential Functions:
- Reviews claims and makes payment determination with authorization limit to $9,999 per claim.
- Conducts research regarding medical appropriateness, coordination of benefits issues, fraud and abuse, and third party liability.
- Checks with lead and supervisor for any claim exceeding $9,999.
- Provides input to Supervisor regarding trends related to training, education to enhance department production and processes.
- Utilizes knowledge of government regulatory policies and procedures to ensure compliance with government regulations including but limited to CMS, DMHC, DHS and requirements of accrediting agencies such as NCQA.
- Proactively works to ensure claims are review & processed timely.
Basic Qualifications:
Experience
- Three (3) to five (5) years Medical claims processing experience in a HMO/Indemnity environment including technical research and
Education
- High School Diploma/GED.
- N/A.
Additional Requirements:
- Claims System OCPS; Windows NT; Word, Excel, Lotus Notes. Excellent skills in communication Medical Claims Processing.
- CPT, ICD-9, Medical Terminology, COB/TPL/WC.
- Demonstrate ability to utilize Medical Terminology and International Classification Diagnosis (ICD-9), HCPCS&CPT coding at a level appropriate to the job.
Preferred Qualifications:
- N/A.
PrimaryLocation : California,Downey,Downey Boeing - Independence Park
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 06:00 AM
WorkingHoursEnd : 02:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : B01|SEIU|Local 399
Job Level : Individual Contributor
Job Category : Insurance & Claims
Department : Independence Park - NCA Ongoing Operating Exp - 0315
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
About Kaiser Permanente
CEO: Gregory Adams
Revenue: $10+ billion (USD)
Size: 10000+ Employees
Type: Nonprofit Organization
Website: http://www.kaiserpermanentejobs.org
Year Founded: 1945
Kaiser Permanente
http://www.kaiserpermanentejobs.org
Oakland, CA
Gregory Adams
$10+ billion (USD)
10000+ Employees
Nonprofit Organization
Health Care Services & Hospitals
1945
