Experienced Claims Examiner - Remote
About The Position
As a key member of our claims processing team, you will ensure compliance with all corporate and departmental standards while meeting regularly with employees to discuss performance and quality. You will be responsible for reporting on Key Performance Metrics (KPIs) to the Executive Director of Claims and the Director of Operations to ensure that adequate resources and technology are in place. Additionally, you will develop and implement departmental standards and expectations, while analyzing and processing a variety of claim files to guarantee adherence to standardized claim protocols and proper claim handling.
Requirements
- At least 3-5 years of experience in medical claims processing operations, claims adjudication.
- Strong understanding of medical terminology, ICD-10, CPT, and HCPCS coding systems.
- Proficient in health claims processing and adjudication.
- Basic to intermediate math skills.
- Proficiency with MS Office Suite.
- Ability to work independently or as part of a team.
Responsibilities
- Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies.
- Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing.
- Process claims end-to-end
- Maintain accurate and detailed records of claims processing activities.
- Review Medicare services for appropriateness of charges and apply pre-existing guidelines during claims processing.
- Pend claims and order medical records for review and investigation of potential misrepresentation.
- Process refunds and letters of dual coverage, when applicable.
- Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues.
- Demonstrate proficiency in CPT-4, ICD-9, and ICD-10 coding, as well as medical terminology.
- Handle any additional responsibilities as assigned by management.
Benefits
- Work/life balance – predictable daytime schedule, no nights
- Paid training to set you up for success
- Comprehensive benefits: Medical, Dental, Vision, Life, HSA, 401(k)
- Paid Time Off (PTO)
- 7 paid holidays
- A supportive team and a company that values internal growth
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
