Medicare Claims Examiner
TEKsystems•Carson, CA
•$29 - $31•Remote
About The Position
CenCal Health is seeking an experienced Medicare Claims Examiner to process and adjudicate Medicare and D-SNP claims. This is a fully remote contract opportunity, and applicants must currently reside in California. Hands-on QNXT experience is required; candidates without it will not be considered. The role involves processing claims in a production-driven environment while meeting productivity, quality, and turnaround-time expectations.
Requirements
- At least 3 years of Claims Examiner or healthcare claims processing experience.
- Medicare and/or Medi-Cal claims processing experience.
- D-SNP experience.
- Health plan experience.
- Strong understanding of claims adjudication and payment determination.
- Experience working in a high-volume production environment.
- Knowledge of CPT, HCPCS, ICD, and HCFA coding.
- Medical terminology knowledge.
- Strong analytical, organizational, and communication skills.
- Ability to work independently in a remote environment.
- Proficiency with Microsoft Office and claims processing systems.
- Hands-on QNXT experience.
- Medicare Advantage and/or D-SNP experience.
- Must currently reside in California.
- Must be comfortable working in a production-driven environment.
Responsibilities
- Review, research, price, and process paper and electronic claims.
- Research and resolve pended and denied D-SNP claims.
- Determine claim payment eligibility and accurately adjudicate claims.
- Review manual review and audit reports.
- Maintain documentation related to CPT, HCPCS, ICD, and HCFA coding.
- Ensure compliance with Medicare, Medi-Cal, CMS, and health plan guidelines.
- Communicate with internal departments regarding claim issues and resolutions.
- Identify trends and support process improvement efforts.
- Meet productivity, quality, and turnaround-time expectations.
Benefits
- Medical insurance, if eligible.
- Dental insurance, if eligible.
- Vision insurance, if eligible.
- Critical illness, accident, and hospital coverage, if eligible.
- 401(k) retirement plan with pre-tax and Roth post-tax contributions, if eligible.
- Voluntary life and AD&D insurance for the employee and dependents, if eligible.
- Short- and long-term disability coverage, if eligible.
- Health Spending Account (HSA), if eligible.
- Transportation benefits, if eligible.
- Employee Assistance Program, if eligible.
- Time off or leave, including PTO, vacation, or sick leave, if eligible.
- Equipment provided by CenCal Health.
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
