Medicaid and Medicare Claims Examiner II

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

📋 Description

• Process assigned healthcare claims in accordance with client-defined guidelines or under the direction of the team leader.

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

• Analyze adjudication system edits to determine the payment eligibility of claims or specific line items.

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

• Provide mentorship to junior team members.

• Collaborate on special initiatives, such as process documentation, training, quality audits, and support during peak activity periods.

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

• Implement preventive measures to ensure accuracy and quality in processing.

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

⛳️ Requirements

• High School diploma is mandatory.

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

• Strong understanding and ability to analyze claims data effectively.

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

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

• Proficiency in ICD-10, CPT, and HCPCS coding is advantageous.

• Eagerness to learn new skills is necessary.

• Ability to work collaboratively within a team.

• Strong work ethic is essential.

• Capacity to adapt swiftly to a dynamic work environment.

• Self-motivated and quick to learn new processes.

• Team player mentality is required.

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

🏝️ Benefits

• Full-time, permanent position.

• Remote work setting.

• Travel may be necessary based on company requirements.

• Reasonable accommodations will be provided for individuals with disabilities.

• Equal opportunity employer dedicated to workforce diversity.