Examiner, I Claims

Position Overview

Grow Healthy – If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference in our communities. As an integral part of a community clinic that raises expectations for quality care, you will be pivotal in ensuring accurate claims processing.

Compensation: $24.00 - $28.15 hourly. Actual salary offers are based on budget, experience, skills, education, licensure, certifications, and other business considerations. This role may also qualify for discretionary bonuses or incentives.

Key Responsibilities

• Analyze and adjudicate medical claims as they relate to managed care.
• Perform payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes.
• Resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries.
• Identify root causes of claims payment errors and report them to Management.
• Respond to provider inquiries and calls related to claims payments.
• Collaborate with other departments and/or providers to successfully resolve claims-related issues.

Required Qualifications

• HS Diploma or GED.
• Some knowledge of Medi-Cal regulations.
• Some knowledge of medical terminology.
• Ability to read and interpret DOFRs and Contracts.

Preferred Qualifications

• Preferred knowledge of Medicare and Commercial rules and regulations.
• Understanding of how to read a CMS-1500 and UB-04 form.
• Strong organizational and mathematical skills.
• Ability to multi-task effectively.

Benefits & Perks

• Medical, Dental and Vision insurance
• 403(b) Retirement savings plans with employer matching contributions
• Flexible Spending Accounts
• Commuter Flexible Spending
• Career Advancement & Development opportunities
• Paid Time Off & Holidays
• Paid CME Days
• Malpractice insurance and tail coverage
• Tuition Reimbursement Program
• Corporate Employee Discounts
• Employee Referral Bonus Program
• Pet Care Insurance