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 the 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 Provider Dispute Resolution (PDR) process or from claims incident/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and Incidents. Collaborates with other departments and/or providers in successful resolution of claims related issues.
Minimum Requirements
1. HS Diploma or GED
2. 3+ years of Claims Processing experience in a managed care environment.
3. Must be knowledgeable of Medi-Cal regulations.
4. Preferred knowledge of Medicare and Commercial rules and regulations.
5. Knowledge of medical terminology.
6. Must have an understanding to read and interpret DOFRs and Contracts.
7. Must have an understanding how to read a CMS-1500 and UB-04 form.
8. Must have strong organizational and mathematical skills.
Compensation
$26.13 - $32.55 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.
What We Do
AltaMed is one of the nation’s largest community health networks. For more than 45 years, we have provided care to patients in the diverse neighborhoods of Los Angeles and Orange counties. For health care professionals committed to their patients, communities and careers, AltaMed is an excellent opportunity to pursue professional goals with pride and distinction.
AltaMed is a non-profit organization, focused on the needs of our patients and the well-being of our communities. Our commitment to community health compels us to look beyond the walls of our offices and clinics and see not just patients, but new possibilities for community wellness. We have many employees who joined us because their families were AltaMed patients and experienced firsthand that our patients are at the center of all we do.
This approach is helping us meet our ambitious goals. We are continually accredited by The Joint Commission (JCAHO), an organization that ensures quality standards in U.S. medical facilities. We’re the first community health network in the nation to have been designated as a Primary Care Medical Home (PCMH). We’re extremely proud of our achievements in patient satisfaction, with our highest scores accomplished during our period of greatest growth. We’ve expanded to 46 Southern California locations, offering primary medical, dental and senior care. We’re active in community outreach and education, and staffed by dedicated professionals committed to patient care.
Continuously looking for ways to do more for more people, AltaMed is leading the industry in bringing new people into our nation's health care system as the top enroller for Covered California. As we continue to grow, we remain at the forefront of evolving health care systems, serving patients with comprehensive care throughout their entire lives. And we will build on our reputation as a rewarding long-term decision for both patients and professionals who believe that quality health care is everyone’s right.
