Claims Examiner III - Medicare Advantage

DescriptionTake on a key role within a world-class, award-winning health system. Contribute to the delivery of award-winning patient care. Take your career in an exciting new direction. You can do all this and more at UCLA Health.You will be responsible for accurate and timely data entry, and the review and adjudication of professional, ancillary, and institutional claims for services rendered in our inpatient, ambulatory and outpatient settings. This will cover all contracted lines of business in accordance with regulatory guidelines, contract provisions, and established policies and procedures. Working from batches, reports, in-basket pools, work queues, or other methods, you will be called on to meet established quality, productivity, service level, and turn-around requirements. This role requires the ability to research and resolve complex claim issues as well as train others on claims processes and workflows.Salary Range:$30.36 - $43.49/HourlyQualificationsWe're seeking a self-motivated, detail-oriented, deadline-driven individual with:High School Diploma, GED or equivalent experienceFour or more years of medical claims payment experience in an HMO settingExpertise in industry standard claims adjudication policies, procedures, and processesIn-depth knowledge of fee schedule and pricing methodologies for outpatient/inpatient institutional, ancillary, and professional claimsExperience processing complex institutional claimsUnderstanding of CPT, HCPCS, ICD-10, ASA, and revenue codesKnowledge of medical terminologyAbility to accurately key 6,000-8,000 keystrokes or type 40-50 WPMComputer proficiency with Microsoft Office and data visualization toolsKnowledge of claims adjudication systems (e.g., EPIC-Tapestry, EZ Cap, QNXT, IDX)Willingness to learn new technologies, practices, and proceduresStrong problem identification, resolution, and analytical abilitiesExcellent communication, interpersonal, critical thinking and organizational skillsUCLA Health is a world-renowned health system with four award-winning hospitals and dozens of primary care practices, specialty practices, urgent care centers, and other ancillary locations throughout metro Los Angeles. We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of Medicine. Through the efforts of our outstanding people, we have become Los Angeles' trusted provider of exceptional, compassionate patient care. If you're looking to experience greater challenge and fulfillment in your career, you can at UCLA Health.