Medicaid Claims Examiner II

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

📋 Description

• Evaluate healthcare claims in accordance with established policies and procedures.

• Examine claims processing system data to assess the appropriateness of services and confirm that benefit coverage criteria are fulfilled.

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

• Handle assigned claims following client-specific guidelines or under the direction of the team leader.

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

• Support the development of junior team members through mentoring.

• Collaborate on special initiatives, such as process documentation, training, quality audits, and providing surge support to clients.

• Keep management informed about any issues and concerns.

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

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

⛳️ Requirements

• High School diploma is mandatory.

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

• Strong understanding and capability to analyze claim data.

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

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

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

• Eagerness to acquire new skills.

• Ability to work collaboratively within a team.

• Strong commitment to work ethics.

• Capacity to adapt swiftly to a dynamic environment.

• Self-motivated and quick to learn.

• Ability to work effectively as a team player.

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

🏝️ Benefits

• Full-time, permanent employment opportunity.

• Flexible remote work environment.

• Opportunity to work across various time zones.

• Potential travel requirements based on company needs.

• Reasonable accommodations are provided for individuals with disabilities in accordance with the Americans with Disabilities Act of 1990.