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Claims Examiner III
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Full-time
- Process claims according to all CMS and DMHC guidelines.
- Process all level of claims including Professional, COB, surgery, skilled nursing, lab, Home Health, ER, hospital (in and outpatient), DME, Pharmacy and radiology claims by applying Prospect’s policy and procedures and all claim payment criteria.
- Minimum Experience: Three to five (3-5) years prior medical claims processing experience required.
- Knowledge of general claims processing principles, CMS claims coding, and UB-04 claims coding, based on at least three to five (3-5) years experience in claims processing preferably in a managed care environment (IPA,MSO)
- Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services.
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