Job Description
Role Snapshot:
- Start Date: Immediate openings available
- Position: Claims Examiner
- Location: Remote
- Company: Workwarp
- Compensation: a competitive salary
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The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements.Summary of Essential Duties and Responsibilities
ΓΒ Enter claim data accurately and timely, in alignment with departmental production and quality goals
ΓΒ Manually price and adjudicate claims as needed.
ΓΒ Maintain a minimum of 98% accuracy at all times
ΓΒ Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines
ΓΒ determination.
ΓΒ Ensure claims payments are made within time frames as reflected in contractual agreements
ΓΒ Identify and refer potential fraud and abuse cases to the Compliance Department
ΓΒ Other duties and responsibilities as may be assigned.
Minimum Requirements
ΓΒ High School diploma or GED equivalent
ΓΒ Minimum of two yearsΓΒ experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience
ΓΒ Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.
ΓΒ Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500)
ΓΒ Strong knowledge of medical terminology
ΓΒ Knowledge of CPT Codes and HCPCs codes
ΓΒ Knowledge of ICD-10 coding
ΓΒ HIPAA regulations
ΓΒ Medicaid and Medicare claim processing experience a plus
ΓΒ Ability to read and interpret general business correspondence, procedure manual, and specific plan document
Abilities Required
ΓΒ Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
ΓΒ Ability to read, write and communicate at a professional level
ΓΒ Effective time management and organizational skills
ΓΒ Effective interpersonal and communication skills Apply Job!
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