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

• Analyze data within the claims processing system to assess the appropriateness of services provided and to verify that benefit coverage criteria are satisfied

• Examine adjudication system edits to decide whether to approve claims and/or specific line items

• Process assigned claims following client-specific guidelines or directions from team leadership

• Achieve productivity goals while maintaining financial and procedural accuracy

• Guide and mentor junior team members

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

• Keep management informed about any issues and concerns

• Implement preventive measures to guarantee processing accuracy and quality

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

⛳️ Requirements

• High School diploma is mandatory

• 1–3 years of experience in healthcare claims processing

• Strong understanding and analytical skills regarding claim data

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

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

• Understanding of UB04 and CMS 1500 forms

• Awareness of authorizations and healthcare concepts

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

• Openness to learning new skills

• Collaborative team player

• Strong work ethic

• Ability to quickly adapt to a dynamic work environment

• Self-motivated and a fast learner

• Capability to work effectively in a team setting

• Availability to work across various time zones in a hybrid or remote setting

• Candidates may be subject to a pre-employment criminal background check

🏝️ Benefits

• Full-time, permanent position

• Opportunity for remote work

• Travel may be required based on company needs

• Reasonable accommodations available for individuals with disabilities

• Equal opportunity employer dedicated to workforce diversity