Claims Examiner; IPA Medical Group

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  • 19-00190
  • Direct Placement
  • Claims
  • Alhambra, CA
Job Description
Claims Examiner I
Process and adjudicates Professional CMS-1500 of encounter claims include pre-logged PCP and/or Pediatric claims.

  • Adjudication of encounter, PCP and Pediatric claim from beginning to end.
  • Knowledge of some ICD-9, CPT, and HCPC codes and annually update
  • Apply all claims policies, contracts, practices and keep in compliance with industry regulations and guidelines
  • Confirm eligibility for claim billed and date of service.
  • Match and link authorization for required claim
  • Comply with claims timeliness guidelines: commercial 45 working days; Medi-Cal 30 calendar days; Medicare non-contracted 30 calendar days and Medicare contracted 60 calendar days.
  • Proficient in and performs the application of "Coordination of Benefits”.
  • Knowledge of Federal and State requirements in claim processing.
  • Identify any overpayment underpayment in a review and or history search. Follow department protocol for reporting and following up.
  • Recognize claim correspondences from multiple IPAs.
  • Recognize the difference between Shared Risk and Full Risk claims.
  • Support the Claims Department as business needs require.
  • Maintains the strictest confidentiality at all times.
  • Complies with all Company and Department Policies and Procedures.
  • All other duties as assigned.


  • High school diploma or general education degree (GED); or one-year related experience and/or training; or equivalent combination of education and experience.
  • Must have knowledge of MS Word and Excel.
  • Knowledge of medical terminology, RVS, CPT, HPCS, ICD-9 codes.

$16.00/hr – $17.00/hr
Additional Information
Full-Time; Benefited


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