This is a fully remote position, open to applicants in United States.

📋 Description

• Process designated healthcare claims following client-defined guidelines or under the direction of a team leader.

• Evaluate claims-processing system data to assess the appropriateness of services and verify that benefit coverage criteria are met.

• Analyze adjudication system edits to decide if claims or line items are eligible for payment.

• Achieve productivity goals along with financial and procedural accuracy benchmarks.

• Provide mentorship to junior team members.

• Collaborate on special initiatives, which may include process documentation, training, quality audits, surge activities, and other assigned projects.

• Maintain open communication with management regarding any issues or concerns.

• Implement preventive measures to guarantee processing accuracy and quality.

• Engage in projects related to provider data, authorizations, enrollment, or other relevant activities.

⛳️ Requirements

• High School diploma is mandatory.

• 1–3 years of experience in healthcare claims processing.

• Strong understanding and capability to analyze claims data.

• Familiarity with physician practices, hospital coding, billing, and medical terminology.

• Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, authorizations, and healthcare concepts.

• Experience with ICD-10, CPT, and HCPCS coding is advantageous.

• Openness to acquiring new skills.

• Ability to work collaboratively within a team.

• Strong work ethic is essential.

• Capacity to quickly adapt to a dynamic work environment.

• Self-motivated and quick to learn.

• Proficiency in collaboration.

• Capability to work across various time zones.

• Candidates may be required to undergo a pre-employment criminal background check.

🏝️ Benefits

• Remote work environment.

• Option for hybrid or fully remote work.

• Travel may be required based on company needs.

• Reasonable accommodations provided for individuals with disabilities.

• Commitment to equal opportunity employment.

• Pre-employment criminal background check process in place.