PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Hospital - Whittier, PIH Health Hospital - Downey and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit or follow us on , , or .
From our extensive facilities in Whittier, California and Downey, California, PIH Health serves more than two million residents in Los Angeles and Orange Counties and throughout the San Gabriel Valley.
The Claims Examiner is responsible for the processing of complex claims (stop loss, etc.) and adjudication and claims research when necessary. He/She must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers.
Required Skills
Experience processing all types of medical claims outpatient/inpatient UB-92 and HCFA-1500 claims as well as others
Dells effectively in a fast-paced, changing environment
Ability to work independently as well as be part of a team
Develops effective working relationships with all levels of the organization, including administration, doctors and staff
Must be familiar with computerized claims processing systems
Data entry and 10-key skills by touch and sight
Knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
Comprehensive medical terminology and knowledge
Efficiency and accuracy of claim payments during processing and adjudication.
Required Experience
High School graduate or G.E.D. is required
Must have a minimum two (2) years of claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment.
Must have knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
Must have thorough understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims.
Experienced in interpreting provider contract reimbursement terms strongly preferred
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
Experience processing all types of medical claims outpatient/inpatient UB-92 and HCFA-1500 claims as well as others
Dells effectively in a fast-paced, changing environment
Ability to work independently as well as be part of a team
Develops effective working relationships with all levels of the organization, including administration, doctors and staff
Must be familiar with computerized claims processing systems
Data entry and 10-key skills by touch and sight
Knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
Comprehensive medical terminology and knowledge
Efficiency and accuracy of claim payments during processing and adjudication.
High School graduate or G.E.D. is required
Must have a minimum two (2) years of claims pricing and processing experience in ambulatory, acute care hospital, HMO or IPA environment.
Must have knowledge of payment methodologies for: Professional (MD), Hospital, Skilled Nursing Facilities, and Ancillary Services
Must have thorough understanding of timeliness and payment accuracy guidelines for commercial, senior and Medi-Cal claims.
Experienced in interpreting provider contract reimbursement terms strongly preferred
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V
