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Claims Examiner II
 Providence Health & Services | |
 United States, California, Los Angeles | |
 July 06, 2022 | |
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Description Claims Examiner II - HMO Claims Processing at Providence Facey Medical Foundation Responsible for processing medical claims. Resolves complex, difficult or non-routine claims requiring special handling in accordance with established policy guidelines. Reviews and authorizes payment and final disposition of claims requiring adjustment and claims benefit determination for reinsurance qualification. Handles complex, difficult or non-routine incoming and outgoing telephone inquiries regarding claims status, benefit quotations, benefit determination and denial information. Interacts with IPAs, Medical Groups, Providers, Hospitals and Members. Responds to written inquiries received from the above-named groups. Required qualifications:
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About the organization you will serve: Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago. Facey is part of Providence, an integrated, not-for-profit network of hospitals, care centers, medical clinics, affiliated services and educational facilities across Alaska, California, New Mexico, Montana, Oregon, Texas and Washington. We offer a full comprehensive range of benefits - see our website for details - http://www.providenceiscalling.jobs/rewards-benefits About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Requsition ID: P360132 Company: Providence Jobs Job Category: Claims Job Function: Revenue Cycle Schedule: Full time Shift: Day Career Track: Admin Support Department: 7011 OTHER FISCAL SERVICES CA PFMF CORPORATE Address: CA Mission Hills 11165 N Sepulveda Blvd Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. | |