About this role
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. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.
Job Overview
A Claims Examiner is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs 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. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Collaborates with other departments and/or providers in the successful resolution of claims-related issues.
Minimum Requirements
HS Diploma or GED.
Must have some knowledge of Medi-Cal regulations.
Must have some Knowledge of medical terminology.
Must understand to read and interpret DOFRs and Contracts.
Preferred knowledge of Medicare and Commercial rules and regulations.
Must have an understanding of how to read a CMS-1500 and UB-04 form.
Must have strong organizational and mathematical skills.
Must be able to multi-task
Compensation
$25.00 - $29.32 hourlyCompensation Disclaimer
Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives.
Benefits & Career Development
- 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
Job Advertisement & Application Compliance Statement
AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.
Other facts
About AltaMed
AltaMed is one of the nation’s largest community health networks. For more than 55 years, we have provided care to patients in the diverse neighborhoods of Los Angeles and Orange counties. For health care professionals dedicated to their patients, communities, and careers, AltaMed offers an opportunity to pursue professional goals with pride and distinction.
As a non-profit organization, we focus on the needs of our patients and the well-being of our communities. Our commitment to community health pushes us to look beyond our offices and clinics and see not just patients, but new possibilities for community wellness. Many of our employees joined us because their families were AltaMed patients and saw firsthand that patients are at the center of all we do.
This approach supports our ambitious goals. We are continually accredited by The Joint Commission (JCAHO), which ensures quality standards in U.S. medical facilities. We were the first community health network in the nation designated as a Primary Care Medical Home (PCMH). We are extremely proud of our patient satisfaction achievements, including our highest scores during our greatest period of growth. We have expanded to 40+ locations in Southern California, offering primary medical, dental, and senior care. We are active in community outreach and education and staffed by dedicated professionals committed to patient care.
Always looking for ways to serve more people, AltaMed leads the industry in bringing new individuals into our nation’s health care system as the top enroller for Covered California. As we continue to grow, we remain at the forefront of evolving health care systems, providing comprehensive care throughout patients’ lives. We will continue to build on our reputation as a rewarding long-term choice for both patients and professionals who believe quality health care is everyone’s right.
What you'll do
- A Claims Examiner is responsible for analyzing and adjudicating medical claims related to managed care. This includes resolving claims payment issues and collaborating with other departments to address claims-related inquiries.
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