Claims Examiner

Correctional Health Partners•Denver, CO

1d•Remote

About The Position

Correctional Health Partners (CHP) specializes in customized third-party administrative (TPA) services. We develop strong working relationships with hospitals and providers with a focus on trust, compassion, and integrity. Our teamwork-driven services ensure that CHP serves the needs of each unique partnership while prioritizing best healthcare practices. We are looking for a Claims Examiner to process provider and facility claims according to the fee schedule/rates specified within the provider’s contracts, while applying the restrictions contained in the benefit plan and coding guidelines. Verifies eligibility and authorization prior to adjudication. Manages workflow to maintain turnaround time requirements. Adjudicates claims within Quality Assurance standards. The position requires a strong understanding of healthcare terminology, claims systems, and payer guidelines , including Medicare, Medicaid, and commercial insurance. Collaborates with other departments in refining/improving processes. Provides feedback to the supervisor on trends and issues observed as opportunities for process improvement. Provides customer service for incoming and outgoing inquiries.

Requirements

High School Diploma/GED
Three to five years’ experience working in a managed healthcare environment.
Minimum of two years’ combined experience processing healthcare claims/appeals or adjudication.
Knowledge of medical terminology, CPT/ ICD-10/HCPC coding, and EOB/EOP interpretation.
Proficiency in claims processing systems
Attention to detail and accuracy
Time management and prioritization
Critical thinking and decision-making
Written and verbal communication
Team collaboration and adaptability
Understanding of HIPAA and confidentiality protocols
Must adhere to CHP’s five core values: Integrity, Teamwork, Accountability, Patient-centered, Compassion.

Nice To Haves

Applicants must live in CO, UT, Fl, TX, OR, TN, MO, SD, OH, MT, IL

Responsibilities

Process provider and facility claims according to the fee schedule/rates specified within the provider’s contracts, while applying the restrictions contained in the benefit plan and coding guidelines.
Verify eligibility and authorization prior to adjudication.
Manage workflow to maintain turnaround time requirements.
Adjudicate claims within Quality Assurance standards.
Collaborate with other departments in refining/improving processes.
Provide feedback to the supervisor on trends and issues observed as opportunities for process improvement.
Provide customer service for incoming and outgoing inquiries.