Medical Claims Examiner

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 Doing

The essential functions listed represent the major duties of this role, additional duties may be assigned.

• Day-to-day processing of claims based on CPT, ICD-10, POS codes, provider types, etc. (medical and mental health claims)
• Claims processing and adjudication.
• Claims research where applicable.
• Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
• Utilize systems to track complaints and resolutions.
• As needed, other responsibilities include resolving researching benefits, verifying correct plan loading, and interacting with claims managers responsible for varying books of business.

Qualifications

• Required: 2+ years related work experience in claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
• Required: Knowledge of CPT, HCPC, RVU, and ICD-10 coding required.
• Required: Enhanced written and verbal communication skills required, including the ability to handle conflict.
• Required: Knowledge of COBRA, HIPAA, and coordination of benefits required.
• Required: Must possess proven judgment, decision-making skills and the ability to analyze.
• Must learn quickly as well as be able to multi-task.
• Must be motivated and possess a sound work ethic.
• Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
• Proficiency using programs for medical CPT coding
• Experience and demonstrated proficiency in processing all types of medical claims.
• Experience in managing claims appeals and correspondence a plus.

General Physical Demands

Sedentary 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-time

Schedule:

• Monday to Friday

Work Location: Remote - In office is optional if in the NYC area.

Job Type: Full-time

Pay: $55,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Health insurance
• Paid time off

Work Location: Remote