Healthcare Claims Processor

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

📋 Description

• Assess, process, and adjudicate medical claims for professionals, facilities, complex cases, and high-dollar amounts.

• Implement program policies, coding standards, and regulatory guidelines during the claim evaluation process.

• Manage claims within stipulated timeframes and rectify discrepancies.

• Address claim variances and work collaboratively with cross-functional teams to identify root causes and implement corrective measures.

• Safeguard member information while adhering to HIPAA and program-specific confidentiality protocols.

• Track and report trends, recurring issues, and irregularities in claims.

• Assist with internal and external audits by providing documentation, clarifying claim outcomes, and validating compliance.

• Aid in operational ramp-ups, managing backlogs, and adapting to changing workload priorities.

• Contribute to the operations of the World Trade Center Health Program’s Third-Party Administrator.

⛳️ Requirements

• A minimum of 5 years of direct experience processing medical professional and facility claims, encompassing complex and high-dollar claims.

• Proficient understanding of ICD-10, CPT, and HCPCS coding systems.

• Proven experience with modifiers, billing types, and standard adjudication procedures.

• Strong grasp of medical terminology, healthcare delivery, and insurance operations.

• Exceptional attention to detail with a track record of accuracy in high-volume processing settings.

• Capability to interpret and apply program policies, payer regulations, and federal guidelines.

• Dedication to continuous training and keeping abreast of coding standards, regulatory modifications, and system updates.

• Experience in claim denial resolution and appeals processes.

• Strong analytical abilities and a customer-service orientation with effective problem-solving skills.

• MBI (T2) public trust/other requirement.

• US citizenship is not mandatory.

🏝️ Benefits

• Comprehensive medical plan options, including some with Health Savings Accounts.

• Dental plan options available.

• Vision plan included.

• 401(k) plan featuring company matching contributions.

• Full-flex work weeks where feasible.

• Paid time off encompassing vacation, sick leave, personal time, holidays, parental leave, military leave, bereavement leave, and jury duty leave.

• Typically, 15 days of paid leave granted per calendar year.

• 10 paid holidays each year.

• Up to 160 hours of paid family leave available within a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits provided.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance options.

• Critical illness insurance available.

• Business travel and accident insurance coverage.

• AI-powered career tool that identifies career progression steps and learning opportunities.

• Internal mobility support team.

• Wellness packages offered.

• Competitive compensation.

• A workplace that is friendly to military personnel.