Job Detail

Overview
We are seeking a detail-oriented and knowledgeable Claims Adjudicator to join our team. In this role, you will be responsible for reviewing and processing claims to ensure compliance with relevant regulations and guidelines. The ideal candidate will possess strong analytical skills and a thorough understanding of medical coding, billing, and documentation practices. You will play a crucial role in maintaining the integrity of our claims process while ensuring timely resolution of discrepancies.

Responsibilities

• Review and analyze claims for accuracy and completeness in accordance with established policies and procedures.
• Utilize knowledge of DRG, ICD-10, and medical terminology to assess claims.
• Ensure compliance with Medicare regulations and workers' compensation law during the adjudication process.
• Communicate effectively with healthcare providers to obtain necessary documentation for claim resolution.
• Maintain organized records of all claims processed, including any correspondence related to the adjudication process.
• Collaborate with team members to identify trends in claim denials and recommend improvements to processes.
• Stay updated on changes in medical coding guidelines and industry regulations that may impact claims processing.

Experience

• Proven experience in medical billing, coding, or documentation is preferred.
• Familiarity with DRG, ICD-10 coding systems, and medical terminology is essential.
• Strong organizational skills with the ability to manage multiple tasks efficiently.
• Knowledge of workers' compensation law and Medicare guidelines is a plus.
• Excellent communication skills, both written and verbal, are required for effective interaction with healthcare providers and internal teams.

Join us as a Claims Adjudicator where your expertise will contribute significantly to our mission of delivering exceptional service in claims processing.

Job Type: Full-time

Pay: $25.00 - $30.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) 3% Match
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Commute:

• Orange, CA 92868 (Required)

Ability to Relocate:

• Orange, CA 92868: Relocate before starting work (Required)

Work Location: In person