Claims Examiner I

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 hourly Compensation 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. As the nation’s largest Federally Qualified Health Center (FQHC), AltaMed is at the forefront of providing affordable, high-quality health care to underserved communities in Los Angeles and Orange Counties. At AltaMed, you will have the opportunity to work with a diverse team of dedicated professionals who are passionate about making a difference and supporting our community of over 400,000 patients. Learn About AltaMed: Click Here AltaMed Health Services Corporation is committed to providing equal employment opportunities for all qualified individuals. We strictly prohibit discrimination in employment based on race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin, age, medical condition, physical or mental disability, military or protected veteran status, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical conditions, genetic information, or any other characteristic protected by local, state, or federal law, ordinance, or regulation. We are committed to promoting equality and inclusivity beyond our recruitment and hiring processes. We aim to create a respectful, valued, and inclusive workplace through training, advancement opportunities, and access to resources and support. We focus on fostering a diverse workforce because it enriches our organization and improves our ability to effectively serve our clients and community. We encourage individuals from all backgrounds to apply and join us in our mission to create a positive impact. Apply Job!