Healthcare Claims Processor

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Claims Review and Processing: Evaluate and manage a range of intricate medical claims in alignment with program policies and procedures, ensuring accuracy and adherence to compliance standards.

• Critical Analysis: Review claims and adjudicate them per program guidelines, utilizing critical thinking to navigate complex scenarios effectively.

• Timely Processing: Guarantee that claims are processed swiftly to meet client expectations and regulatory mandates, applying effective problem-solving skills to overcome any obstacles.

• Issue Resolution: Actively resolve discrepancies and issues related to claims by collaborating with various departments, employing analytical skills to identify root causes and execute solutions.

• Confidentiality Maintenance: Maintain the confidentiality of patient records and company information in accordance with HIPAA regulations.

• Detailed Record Keeping: Keep comprehensive records of claims that are processed, denied, or require additional investigation, ensuring transparency and traceability.

• Trend Monitoring: Analyze and report trends in claim issues or irregularities to management, contributing to initiatives for process improvement; assists Team Leads with reporting.

• Audit Participation: Participate in audits and compliance reviews to ensure conformity with internal and external regulations, using critical thinking to assess processes.

• Mentoring: Provide mentorship and training to new claims processors as necessary.

⛳️ Requirements

• High school diploma or equivalent qualification.

• At least 5 years of experience in processing medical professional and facility claims, including complex and high-dollar claims.

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

• Experience with modifiers and bill types is essential.

• Familiarity with medical terminology, healthcare services, and insurance procedures (experience with worker’s compensation is advantageous).

• Exceptional attention to detail and accuracy.

• Ability to interpret and apply insurance program policies and government regulations effectively.

• Excellent written and verbal communication skills.

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

• Capacity to work independently as well as collaboratively within a team environment.

• Commitment to ongoing education and training in industry standards and advancements in technology.

• Experience with resolving claim denials and navigating the appeals process.

• Ability to manage a high volume of claims efficiently.

• Customer service-oriented with strong problem-solving skills.

• Flexibility and the ability to adapt to client needs and changes in the program.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance options.

• Retirement savings plan with employer matching contributions.

• Ongoing professional development and training opportunities.

• Flexible work hours and remote work options.

• Generous paid time off and holiday schedule.