Top 109 Medical claims Jobs in Fairfield, Ca

Claims Examiner II
Partnership HealthPlan of California —Fairfield, CA
- $31.45 - $37.74 an hour
- Research
- Mid-level
- Office
Patient Account Representative, Billing (On-Site, Hybrid, Remote)
Northbay Healthcare —Fairfield, CA
- $32.51 an hour
- Full-time
- Hybrid work
- Word processing
- Computer literacy
- 11+ years
- 403(b) matching
- Health insurance
Patient Account Representative III Hospital Billing, Remote, Hybrid,Onsite
Northbay Healthcare —Fairfield, CA
- $32.15 an hour
- Full-time
- Hybrid work
- Word processing
- Computer literacy
- Mid-level
- 403(b) matching
- Health insurance
Patient Access Ambassador II (Per Diem, Evening)
Northbay Healthcare —Fairfield, CA
- $33.23 an hour
- 8 hour shift
- Hybrid work
- Customer service
- Writing skills
- Mid-level
- 403(b) matching
- Health insurance
Configuration Quality Assurance Analyst I
Partnership HealthPlan of California —Fairfield, CA
- $77,430.47 - $96,788.08 a year
- Computer literacy
- Mid-level
- Office
Patient Services Rep (Full Time, Days) Neurosurgery Clinic
Northbay Healthcare —Fairfield, CA
- $26 an hour
- Full-time
- Hybrid work
- BLS Certification
- HIPAA
- Mid-level
- 403(b) matching
- Health insurance
Financial Verification HIM Ambassador (Per Diem)
Northbay Healthcare —Fairfield, CA
- $37.35 an hour
- Full-time
- 5 years
- Mid-level
- Organizational skills
Patient Services Rep, Neurology (Per Diem, Days)
Northbay Healthcare —Fairfield, CA
- $26 an hour
- Full-time
- Hybrid work
- BLS Certification
- Mid-level
- Neurology
- 403(b) matching
- Health insurance
Patient Care Coordinator - Treatment, Scheduling & Insurance
Tara Hills Dental —Pinole, CA
- $29 - $37 an hour
- Full-time
- Private practice
- Dental office
- 5 years
- Free parking
- Profit sharing
Quick Apply
Medical Billing Specialist
Muir Pulmonary Critical Care —Walnut Creek, CA
- From $25 an hour
- Full-time
- Microsoft Excel
- Mid-level
- High school diploma or GED
- Paid holidays
- Health insurance
Quick Apply
Part-time Therapist
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply
Remote Mental Health Provider (LMFT)
Telemynd —California
- $100,000 - $150,000 a year
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- LPC
- Dental insurance
- Vision insurance
Quick Apply
Remote Therapist (LMFT, LCSW, LPCC)
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply
Remote Therapist (LMFT, LCSW, LPCC)
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply
Remote Clinical Social Worker (LMFT, LCSW, LPC, LPCC)
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply
Remote Licensed Marriage & Family Therapist
Grow Therapy —California
- $70 - $98 an hour
- Part-time
- Remote
- LMFT
- Mid-level
- Telehealth
- Continuing education credits
- Professional development assistance
12d
Licensed Professional Clinical Counselor
Grow Therapy —California
- $70 - $98 an hour
- Part-time
- Remote
- Mid-level
- Psychology
- In-person
- Continuing education credits
- Professional development assistance
12d
Licensed Marriage and Family Therapist
Telemynd —California
- From $70 an hour
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Flexible schedule
Quick Apply
Licensed Clinical Social Worker
Grow Therapy —California
- $70 - $98 an hour
- Part-time
- Remote
- Licensed Clinical Social Worker
- Mid-level
- In-person
- Continuing education credits
- Professional development assistance
12d
Mental Health Therapist (LMFT, LCSW, LPCC)
Sensible Care —California
- $90,000 - $100,000 a year
- Full-time
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Continuing education credits
- Paid holidays
Quick Apply

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Claims Examiner II

Partnership HealthPlan of California -
Fairfield, CA

Apply Now

Job Details

$31.45 - $37.74 an hour

Qualifications

High school diploma or GED
Typing

Full Job Description

Overview

To review, research, and resolve claims for all Medi-Cal claim types within established production and quality standards, including manual processing. Completes and processes claims and claims worksheets. Creates appropriate documentation that reflects the actions taken and status of the claim. Generates provider communication, such as letters, as necessary. Routes and tracks claims requiring review by other staff and departments, and processes when possible. Claims Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience, as well as an ability to process a wider range of claim types.

Responsibilities

Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary, long term care, CHDP, encounter data, other coverage, and batch claims within established production and quality standards. Completes claims from the Batch Error Report and Batch Pass Report.
Routes claims to appropriate Partnership departments and internal staff for additional review. Follows up and completes claims once response to request has been received.
Follows established Partnership policies and procedures, Partnership Claims Operating Instruction Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22 regulations, and CMS guidelines when resolving pended claims.
Generates claims correspondence as needed.
Records daily production statistics and related activities on appropriate reports. Turns in all logs and reports to the Medi-Cal Claims Supervisor.
Reviews all work audits in a timely manner and submits any adjustments and corrections within the allotted time frame.
Supports Claims Department’s needs for resolving all pended claim types.
Participates in special projects and assignments as required.
Identifies and reports trends of pending claims that are increasing or processes that appear dated.
Recognizes and gives feedback to management on procedure changes that would result in more efficient operations.
Other duties as assigned.

Qualifications

Education and Experience

High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment.

Special Skills, Licenses and Certifications

Effective written and oral communication skills. Good organization skills. Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD-10 knowledge preferred.

Performance Based Competencies

Ability to effectively exercise good judgement within scope of authority and handle sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to accurately complete tasks within established timelines. Consistently meets production standards without compromising quality on all tasks.

Work Environment And Physical Demands

Ability to use a microcomputer keyboard. More than 95% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$ 31.45 - $ 37.74

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Apply Now

Refine Your Search

medical claims jobs in fairfield, ca

Claims Examiner II

Patient Account Representative, Billing (On-Site, Hybrid, Remote)

Patient Account Representative III Hospital Billing, Remote, Hybrid,Onsite

Patient Access Ambassador II (Per Diem, Evening)

Configuration Quality Assurance Analyst I

Patient Services Rep (Full Time, Days) Neurosurgery Clinic

Financial Verification HIM Ambassador (Per Diem)

Patient Services Rep, Neurology (Per Diem, Days)

Patient Care Coordinator - Treatment, Scheduling & Insurance

Medical Billing Specialist

Part-time Therapist

Remote Mental Health Provider (LMFT)

Remote Therapist (LMFT, LCSW, LPCC)

Remote Therapist (LMFT, LCSW, LPCC)

Remote Clinical Social Worker (LMFT, LCSW, LPC, LPCC)

Remote Licensed Marriage & Family Therapist

Licensed Professional Clinical Counselor

Licensed Marriage and Family Therapist

Licensed Clinical Social Worker

Mental Health Therapist (LMFT, LCSW, LPCC)

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