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Job Field: Legal Jobs
Location: Torrance, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Claims Specialist 2Req: 11782Department: IMCS - ClaimsSchedule: Full TimeShift: DaysHours: M-F 8AM-430PMJob Details: * High School/GED* More than 3 years of experience required* HealthCare Partners Medical Group is a multispecialty medical group that is recognized for its quality of care and high rates of patient satisfaction. HealthCare Partners has over 3,500 employees, including 500+ primary care and specialty physicians, caring for more than 500,000 patients throughout<?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />Los AngelesCountyandNorthernOrangeCounty. HCP operates 40 medical clinics, five urgent care centers, two medical spas, and an ambulatory surgery center. If you''re looking to make a difference with a large, financially stable, well-recognized, privately-owned Medical Group.HealthCare Partners may be the employer for you. We are currently seeking aClaims Specialist 2:Responsiblefor processing all professional medical claims, appeals, and prepayment audits for payment, denial or referral for the appropriate payor. Answers incoming telephone inquiries and accurately and thoroughly documents problems and resolutions. Troubleshoots claims that have been identified as needing additional work in the areas of eligibility, referral / authorization, contracting and / or provider set-up. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />Required:* High school diploma, G.E.D. or equivalent. Includes special certification required for specific jobs.* Over 3 years and up to and including 5 years of experience in an indemnity and / or HMO setting processing, auditing or adjusting professional claims.* Computer literate.* Knowledge of Microsoft Office products.* Individual must be reliable, dependable, and punctual.* Excellent customer service and telephone skills.* Excellent verbal and written communication skills.* Ability to work in an environment with fluctuating workloads.* Ability to solve problems systematically, using sound business judgment.* Ability to make decisions with every call and handle escalated issues.* Ability to make decisions regarding escalation of referrals to Care Management.* Familiarity with ICD-9 and CPT codes.* Knowledge of all types of professional claims* Ability to research and verify claims payment issues.* Knowledge of compliance related to the processing of claims.* Knowledge of medical terminology and pricing options.* Knowledge of different sources of authorization documentation.* Ability to read and interpret all vendor contracts.HR Use Only:

KEY REQUIREMENTS:

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