Pasadena, CA · Remote
$22 - $30/hr
... processes. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes * Must have at least 2 years of applicable healthcare claims adjudication experience within the ...
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Pasadena, CA · Remote
$22 - $30/hr
... processes. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes * Must have at least 2 years of applicable healthcare claims adjudication experience within the ...
The selected candidate will be responsible for maintaining EDI transaction processing, healthcare claims adjudication workflows, provider integrations, and supporting modernization efforts as the ...
The selected candidate will be responsible for maintaining EDI transaction processing, healthcare claims adjudication workflows, provider integrations, and supporting modernization efforts as the ...
Minneapolis, MN · On-site
$22 - $25/hr
The Healthcare Claims Auditor serves clients, employers and members. This individual will ... Minimum of 5 years claims processing experience * Detail oriented with excellent written and verbal ...
Minneapolis, MN · On-site
$22 - $25/hr
The Healthcare Claims Auditor serves clients, employers and members. This individual will ... Minimum of 5 years claims processing experience * Detail oriented with excellent written and verbal ...
... rates Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines ... are claims adjudication experience within a managed care industry Must be familiar with ICD-10, ...
... rates Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines ... are claims adjudication experience within a managed care industry Must be familiar with ICD-10, ...
Long Beach, CA · On-site
$19.84 - $38.69/hr
Applies claims processing and technical knowledge to appropriately define a path for short ... Preferred Qualifications Health care claims analysis experience. Project management experience ...
Long Beach, CA · On-site
$19.84 - $38.69/hr
Applies claims processing and technical knowledge to appropriately define a path for short ... Preferred Qualifications Health care claims analysis experience. Project management experience ...
Miami, FL · On-site
By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...
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Miami, FL · On-site
By collaborating with claims processors, healthcare providers, and compliance teams, the auditor helps to streamline claims management and reduce errors. Ultimately, this role supports the delivery ...
Oversees the refund process and the request of refunds/overpayments from providers. Maintains ... Interacts and communicates effectively inside and outside NorthBay Healthcare. * Oversees Managed ...
Oversees the refund process and the request of refunds/overpayments from providers. Maintains ... Interacts and communicates effectively inside and outside NorthBay Healthcare. * Oversees Managed ...
$30 - $32/hr
Claims Operations Manager Description The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures ...
$30 - $32/hr
Claims Operations Manager Description The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures ...
Fairfield, CA · On-site
$33.29 - $40.44/hr
Oversees the refund process and the request of refunds/overpayments from providers. Maintains ... Interacts and communicates effectively inside and outside NorthBay Healthcare. * Oversees Managed ...
Fairfield, CA · On-site
$33.29 - $40.44/hr
Oversees the refund process and the request of refunds/overpayments from providers. Maintains ... Interacts and communicates effectively inside and outside NorthBay Healthcare. * Oversees Managed ...
$30 - $32/hr
Claims Operations Manager Description The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures ...
$30 - $32/hr
Claims Operations Manager Description The Claims Operations Manager is responsible for overseeing the end-to-end claims processing function within a healthcare payer environment. This role ensures ...
Long Beach, CA · On-site +1
$129K/yr
Analyze claims from compliance against contracts, billing, and processing guidelines * Assist with ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Long Beach, CA · On-site +1
$129K/yr
Analyze claims from compliance against contracts, billing, and processing guidelines * Assist with ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Crandon, WI · On-site
... Care, medical, dental and vision claims Analyzes and processes minimum of 400 claims to determine ... Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases ...
Crandon, WI · On-site
... Care, medical, dental and vision claims Analyzes and processes minimum of 400 claims to determine ... Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases ...
Honolulu, HI · Hybrid
$30 - $32/hr
TEKsystems is seeking a Claims Specialist to support a leading healthcare payer organization in Hawaii. This role focuses on supporting end-to-end claims processing operations, ensuring accurate and ...
Honolulu, HI · Hybrid
$30 - $32/hr
TEKsystems is seeking a Claims Specialist to support a leading healthcare payer organization in Hawaii. This role focuses on supporting end-to-end claims processing operations, ensuring accurate and ...
Role Overview The client is seeking an EDI Expert to support healthcare claims processing, EDI transaction management, provider onboarding, and claims adjudication activities within a healthcare ...
Role Overview The client is seeking an EDI Expert to support healthcare claims processing, EDI transaction management, provider onboarding, and claims adjudication activities within a healthcare ...
At least 2-5 years in healthcare claims processing, claims operations, or related healthcare administrative role * Experience creating, maintaining, or updating policies, procedures, or technical ...
At least 2-5 years in healthcare claims processing, claims operations, or related healthcare administrative role * Experience creating, maintaining, or updating policies, procedures, or technical ...
... Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines ... are claims adjudication experience within a managed care industry Must be familiar with ICD-10, ...
... Health Plan procedures Medicare and Medi-cal reimbursement Claims processing guidelines ... are claims adjudication experience within a managed care industry Must be familiar with ICD-10, ...
Knowledge of healthcare claims processing and member/provider workflows. * Experience working with Java-based enterprise applications. * Experience supporting React-based web platforms/applications.
Knowledge of healthcare claims processing and member/provider workflows. * Experience working with Java-based enterprise applications. * Experience supporting React-based web platforms/applications.
Long Beach, CA · On-site +1
$14.90 - $29.06/hr
... processing errors. Essential Job Duties • Evaluates the adjudication of claims using standard ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Long Beach, CA · On-site +1
$14.90 - $29.06/hr
... processing errors. Essential Job Duties • Evaluates the adjudication of claims using standard ... Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Long Beach, CA · Remote
$14.90 - $29.06/hr
... processing errors. Essential Job Duties Evaluates the adjudication of claims using standard ... Preferred Qualifications Health care claims/billing experience. #PJClaims3 #LI-AC1 To all current ...
Long Beach, CA · Remote
$14.90 - $29.06/hr
... processing errors. Essential Job Duties Evaluates the adjudication of claims using standard ... Preferred Qualifications Health care claims/billing experience. #PJClaims3 #LI-AC1 To all current ...
New York, NY · On-site
$48K - $50K/yr
Minimum 2 years of claims operations experience in a healthcare field, with knowledge of integrated claims processing required. * Experience using a PC and claim adjudication system(s) * Experience ...
New York, NY · On-site
$48K - $50K/yr
Minimum 2 years of claims operations experience in a healthcare field, with knowledge of integrated claims processing required. * Experience using a PC and claim adjudication system(s) * Experience ...
$12.02 - $13.33
2% of jobs
$13.33 - $14.64
6% of jobs
$14.64 - $15.95
9% of jobs
$16.63 is the 25th percentile. Wages below this are outliers.
$15.95 - $17.26
14% of jobs
$17.26 - $18.58
18% of jobs
The median wage is $18.62 / hr.
$18.58 - $19.89
17% of jobs
$20.61 is the 75th percentile. Wages above this are outliers.
$19.89 - $21.20
16% of jobs
$21.20 - $22.51
7% of jobs
$22.51 - $23.82
4% of jobs
$23.82 - $25.13
4% of jobs
$25.13 - $26.44
2% of jobs
$12
$19
$26
| Aspect | Healthcare Claims Processing | Medical Billing Specialist |
|---|---|---|
| Primary Role | Reviewing and submitting insurance claims for reimbursement | Creating and managing patient invoices and billing records |
| Credentials | Knowledge of insurance policies, coding, and claims software | Knowledge of billing procedures, coding, and insurance requirements |
| Work Environment | Healthcare facilities, insurance companies, or billing companies | Medical offices, hospitals, or billing service providers |
| Industry Usage | Used across healthcare providers and insurance payers | Primarily in healthcare provider settings |
While both roles involve coding and insurance knowledge, Healthcare Claims Processing focuses on submitting and managing insurance claims, whereas Medical Billing Specialists handle patient billing and invoicing. Both roles are essential for revenue cycle management in healthcare organizations.
Pasadena, CA • Remote
$22 - $30/hr
Full-time
Posted 10 days ago
JOB TITLE: Claims Examiner
***Remote / Hybrid work offered when metrics are exceeded and sustained.***
JOB SUMMARY: Responsible for adjudicating complex claims, which include high-dollar claims. Responsible for accurate manual/auto pricing of claims. Identify provider billing issues that impact claims processing. Works closely with the Supervisor to identify any reporting or training needs and system problems that may be encountered. Maintains quality and production standards, teamwork, and complies with company/administrative policies and guidelines.
ESSENTIAL JOB FUNCTIONS:
Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits, i.e. co-payment, deductible, etc.
Review and process facility (UB-04) and professional claims (CMS-1500).
Process claims based on contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups’ and company policies and procedures.
Process Medicare member claims based on DMHC and DHS regulatory legislature.
Respond to and resolve provider and health plan claims inquiries and give resolution in a timely manner.
Review services for appropriateness of charges and apply authorization guidelines during claims processing.
Monitor and track age, pended, and open reports to maintain timeliness in claims processing based on individual work allocation report.
Maintain quality and productivity standards, teamwork, and comply with company/administrative guidelines.
Ensures compliance with all applicable Federal, State and/or County laws and regulations related to our documented guidelines and processes.
Adheres to payroll policies and properly uses timekeeping system with minimal manual changes
