Medicaid Claims Examiner II

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

📋 Description

• Process claims assigned to you in accordance with client-specific guidelines or as directed by the team leader.

• Achieve productivity goals while adhering to financial and procedural accuracy standards.

• Evaluate data from the claims-processing system to assess the appropriateness of services and whether benefit coverage criteria have been satisfied.

• Analyze adjudication system edits to make decisions on the payment of claims and/or line items.

• Provide mentorship to junior team members.

• Collaborate on special projects, which may include process documentation, training, quality audits, and surge activities.

• Communicate with management regarding issues and concerns while implementing preventive measures to uphold processing accuracy and quality.

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

• Report directly to the Claims Team Leader.

⛳️ Requirements

• A High School diploma is mandatory.

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

• A strong understanding and ability to analyze claim data is essential.

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

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

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

• A willingness to acquire new skills is essential.

• Must be a team collaborator.

• A strong work ethic is required.

• Ability to quickly adapt to a fast-paced environment is crucial.

• Must be a self-starter with a quick learning ability.

• A team player with strong collaboration skills is necessary.

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

🏝️ Benefits

• Flexible remote work environment.

• Hybrid or remote work options available across multiple time zones.

• Travel may be required based on company needs.

• Reasonable accommodations will be provided for individuals with disabilities.

• An equal opportunity employer dedicated to workforce diversity.