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

📋 Description

• Evaluate healthcare claims by adhering to established policies and procedures.

• Analyze claims-processing system data to assess the appropriateness of services and verify compliance with benefit coverage criteria.

• Examine adjudication system edits to make informed decisions on whether to approve claims or specific line items.

• Handle assigned claims in accordance with client-specific guidelines or instructions from the team leader.

• Achieve productivity goals while maintaining accuracy in financial and procedural standards.

• Provide guidance and mentorship to junior team members.

• Collaborate on special initiatives, including process documentation, training sessions, quality audits, client surge activities, and other designated tasks.

• Engage with management to address issues and concerns, implementing preventive measures to enhance processing accuracy and quality.

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

⛳️ Requirements

• A High School diploma is required.

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

• Strong understanding and ability to analyze claim data effectively.

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

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

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

• A willingness to acquire new skills.

• Ability to work collaboratively within a team.

• Strong work ethic and dedication to quality.

• Capability to adapt swiftly to a dynamic work environment.

• Self-motivated and able to learn quickly.

• Ability to function effectively as a team player.

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

🏝️ Benefits

• Full-time, permanent employment opportunity.

• Remote working environment.

• Travel may be required based on company needs.

• Reasonable accommodations available for individuals with disabilities.

• An equal opportunity employer dedicated to fostering workforce diversity.