Claims Reviewer - PACE - Kearny Mesa
San Diego On-site
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About the role
A Claims Reviewer is responsible for assisting the Claims Analyst and Supervisor in adjudication of all claims as it relates to San Diego PACE Program. Reviews participant statements to resolve outstanding participant responsibility. Initiates payment reconciliations and/or adjustments related to contract rate and fee schedule changes. Assist with provider claims and payment issues from claims incident/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims and payments. Collaborates with other departments and/or providers in successful resolution of claims related issues.
What you'll bring
- 2 years of claims review experience.
- High School Diploma/GED or equivalent experience.
- None.
- Excellent interpersonal skills.
- Excellent verbal and written communication skills.
- Knowledge of Medi Cal and Medicare Regulations.
- Knowledge of medical terminology, including but not limited to, ICD10
- HCPC
- CDT
- and PPS.
- Strong ability to read and interpret contracts.
- Must have a familiar understanding of CMS-1500 and UB-04 claim form requirements.