Job Description
Duration: + months contract
Responsibilities:
Review, adjudicate, and process medical claims for HMO patients Work closely with affiliated medical groups and hospitals Evaluate provider reimbursement terms and flag non-contracted providers Ensure claims are processed accurately and timely per policy guidelines
Experience:
+ years of experience in claims adjudication (HMO, IPA, or hospital environment)
Skills: Claims reimbursement knowledge Experience working with DOFR (Division of Financial Responsibility) Hands-on experience processing lab claims Familiar with UB- and HCFA- forms Understanding of provider contracts, Medi-Cal, commercial, and senior plan claims Strong knowledge of timeliness, payment accuracy, and compliance standards Basic computer and data entry skills
Education:
High sc...
Apply for this Position
Ready to join US Tech Solutions? Click the button below to submit your application.
Submit Application