Medicare Claims Examiner
Company: Impresiv Health
Location: San Diego
Posted on: January 9, 2026
|
|
|
Job Description:
Job Description Medicare Claims Examiner No third parties
Location: Remote, must reside in California Description: This
position is responsible for: researching, correcting and responding
to all D-SNP pended claims as well the review of Audit reports in a
timely manner; determining whether a claim should be paid (in
accordance with the policies and procedures) and maintaining
correspondence for document procedure /medical/CPT/ HCFA codes;
assuring all regulatory guidelines are being followed. What You
Will Do: Review, price and release claims associated with the
assigned claim types (paper and electronic) Review Manual Review
reports that suspend for review for D-SNP claims Keep up to date on
all D-SNP policies and provide materials for improvement projects
within Department Assure all regulatory guidelines are being
followed and monitored Maintain daily activity log Assist with the
processing of claims Other duties and projects assigned You Will Be
Successful If: Strong knowledge of QNXT Strong knowledge of the
D-SNP program Strong knowledge in dual eligible claims processing
(Medi-Cal and Medicare D-SNP) Prior experience in high volume
production environment Good oral and written communication skills
Attention to detail Medical terminology and/or coding experience is
highly desirable What You Will Bring: High school diploma or
equivalent. 3 years experience as a Claims Examiner. 3 years
experience processing Medicare Claims and DSNP Claims. 2 years
experience working with QNXT, preferably versions 6.0,6.1,5.0, or
5.1. About Impresiv Health: Impresiv Health is a healthcare
consulting partner specializing in clinical & operations
management, enterprise project management, professional services,
and software consulting services. We help our clients increase
operational efficiency by delivering innovative solutions to solve
their most complex business challenges. Our approach is and has
always been simple. First, think and act like the customers who
need us, and most importantly, deliver what larger organizations
cannot do – provide tangible results that add immediate value, at a
rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!
Keywords: Impresiv Health, Santa Ana , Medicare Claims Examiner, Accounting, Auditing , San Diego, California
