Abrar Admin

Covet Health

Job description:** This role requires a minimum of 2 years of working at a healthcare payer as a claims processor/examiner. **The Claim Examiner primary focus includes handling claim processing and adjudication, with claims research where applicable. Claims processing may range in level of complexity and requires knowledge in ICD-10, CPT, POS, RVU, and HCPC coding.What Will You Be DoingThe essential functions listed represent the major duties of this role, additional duties may be assigned.<ul><li>Day-to-day processing of claims based on CPT, ICD-10, POS codes, provider types, etc. (medical and mental health claims)</li><li>Claims processing and adjudication.</li><li>Claims research where applicable.</li><li>Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).</li><li>Utilize systems to track complaints and resolutions.</li><li>As needed, other responsibilities include resolving researching benefits, verifying correct plan loading, and interacting with claims managers responsible for varying books of business.</li></ul>Qualifications<ul><li>Required: 2+ years related work experience in claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.</li><li>Required: Knowledge of CPT, HCPC, RVU, and ICD-10 coding required.</li><li>Required: Enhanced written and verbal communication skills required, including the ability to handle conflict.</li><li>Required: Knowledge of COBRA, HIPAA, and coordination of benefits required.</li><li>Required: Must possess proven judgment, decision-making skills and the ability to analyze.</li><li>Must learn quickly as well as be able to multi-task.</li><li>Must be motivated and possess a sound work ethic.</li><li>Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.</li><li>Proficiency using programs for medical CPT coding</li><li>Experience and demonstrated proficiency in processing all types of medical claims.</li><li>Experience in managing claims appeals and correspondence a plus.</li></ul>General Physical DemandsSedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.Job Type: Full-timeSchedule:<ul><li>Monday to Friday</li></ul>Work Location: Remote - In office is optional if in the NYC area.Job Type: Full-timePay: $55,000.00 - $65,000.00 per yearBenefits:<ul><li>401(k)</li><li>Health insurance</li><li>Paid time off</li></ul>Work Location: Remote

Medical Claims Examiner

Join Covet Health and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Covet Health

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Medical Claims Examiner