Healthcare

Hire the right healthcare staff with speed and precision locally or nationwide.

Learn More

How to Cost-Effectively Build a Nursing Staff in an Age of Travel Nursing

Uncover alternative and sustainable staffing solutions to address nursing shortages

Read the article

Life Sciences

Hire skilled life sciences talent by partnering with a nationwide recruitment agency with local market expertise.

Current Trends in the Life Sciences Job Market

Learn how partnering with a staffing agency is a powerful way to combat the challenges of hiring in the current life sciences job market

Read the article

Technology

Execute critical healthcare IT initiatives with increased flexibility and cost-effectiveness with us at your side.

The Technology Hiring Outlook: What We're Seeing Right Now

Uncover how to handle an employee-led technology market.

read the article

For JobSeekers

Match your unique skills with in-demand jobs at growing organizations.

Learn More

Resource Center

Explore our library of insights and tips designed to help healthcare leaders and job candidates align.

Explore resources

About Us

We’re positively impacting lives as a leading provider of workforce solutions for clients and talent.

Learn More

Back to jobs

Claims Representative

Posted: September 06, 2024
Salary:US$25 - US$28 per hour
Location:El Segundo
Job type: Contract
Discipline:Revenue Cycle
Reference:233200_1725646770
Work Location:Hybrid

Job description

Location: Remote (Required to attend onsite training in El Segundo, CA)
Hours: Monday - Friday, 6:00 AM - 2:30 PM

Job Summary:
We are seeking a detail-oriented and experienced Medical Claims Reviewer to join our team. The ideal candidate will be responsible for reviewing medical claims, ensuring compliance with regulatory standards, and working within various computer systems. This position requires strong analytical skills and the ability to manage multiple tasks simultaneously.

Key Responsibilities:

- Review medical claims submitted with and without prior authorization.
- Attach necessary medical records to claims to ensure completeness and accuracy.
- Engage with claims and clinical claims review teams to discuss trends identified during retrospective claims reviews.
- Provide insights and feedback to improve the claims review process.
- Review and re-direct inappropriate retro referral requests to the appropriate parties.
- Ensure that referral management is aligned with departmental standards.
- Comply with company and departmental standards for the timeliness of review and claims payment.
- Ensure consistency with regulatory standards related to claims turnaround time.
- Request medical records in a timely manner in accordance with regulatory and departmental compliance requirements.
- Maintain accurate records of all requests and follow-ups.
- Enter and update authorizations in the computer systems, including GE, IDX, and CURO.
- Ensure that all entries are accurate and up to date.

Qualifications:
- Strong knowledge of Microsoft Word, Excel, and Teams.
- Ability to work with multiple computer applications simultaneously.
- Attention to detail and strong organizational skills.
- Prior experience in medical claims review or a related field