Claims Examiner II

Claims Examiner II: needed for a contract opportunity with Yoh's client located in Redding, CA!
Top Skills You Should Possess:

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

What You'll Be Doing:

• 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 departments and internal staff for additional review.
• Follows up and completes claims once response to request has been received.
• Follows established policies and procedures, 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.

What You Need to Bring to the Table:

• High school diploma or equivalent; minimum one (1) year in Medi-Cal billing and/or claims examining experience in an automated environment.
• Effective written and oral communication skills. Good organization skills.
• Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD- 10 knowledge preferred.
• 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.
• 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.
• 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.

Any pay ranges displayed are estimations which may have been provided by job boards. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.
What's In It For You?
We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh's network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh's extensive talent community that will provide you with access to Yoh's vast network of opportunities.

• Medical, Dental & Vision Benefits
• 401K Retirement Saving Plan
• Life & Disability Insurance
• Direct Deposit & weekly EPayroll
• Employee Discount Programs
• Referral Bonus Programs

What are you waiting for? Apply Now!
Recruiter: Arlet Khachikyan
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK.

Estimated Min Rate : $18.20
Estimated Max Rate : $26.00

Note: Any pay ranges displayed are estimations. Actual pay is determined by an applicant's experience, technical expertise, and other qualifications as listed in the job description. All qualified applicants are welcome to apply.

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Visit to contact us if you are an individual with a disability and require accommodation in the application process.

For California applicants, qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. All of the material job duties described in this posting are job duties for which a criminal history may have a direct, adverse, and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.