Claims Processor II - ICD 9/10 CPT Required - Remote US
About The Position
Responsible and accountable for the accurate and timely processing of claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and the terms of customer/provider contractual agreements. The role adjudicates claims and adjustments, resolves claims edits and suspended claims, and maintains and updates reference materials needed for adjudication. It manually prices claims using various tools and processes and reviews reference-material updates daily, sharing feedback or suggestions when concerns arise. The processor provides backup support to other team or group members as assigned and partners with the Quality team for clarification on procedures and complex claims, receiving coaching from leadership. The listed duties are representative and not all-inclusive; a leader may assign additional duties aligned with the job's intent.
Requirements
- Medical or healthcare claims processing experience.
- Claims work experience.
- Experience with ICD-9/10 codes and Current Procedural Terminology (CPT).
- GED or high school education.
- Demonstrated ability to navigate computer applications.
- Basic analytical skills.
- Basic written and oral communication skills.
- Reading comprehension and ability to follow provided directions.
Responsibilities
- Accurately and timely process claims in accordance with claims payment policy and customer/provider contractual agreements.
- Adjudicate claims and adjustments.
- Resolve claims edits and suspended claims.
- Maintain and update reference materials required to adjudicate claims.
- Provide backup support to other team or group members as assigned.
- Manually price claims using various tools and processes.
- Review reference-material updates daily and share feedback or suggestions about concerns.
- Partner with the Quality team for clarification on procedures and complex claims, and receive coaching from leadership.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
