Medical Claims Processor I – Temporary Role

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

📋 Description

• Evaluate and process a range of intricate medical claims in line with program policies and procedures, ensuring both accuracy and compliance.

• Adjudicate claims based on program guidelines, utilizing critical thinking skills to handle complex scenarios.

• Guarantee timely processing of claims to align with client standards and regulatory mandates.

• Identify and address any obstacles using effective problem-solving techniques.

• Collaborate with internal departments to proactively resolve discrepancies and issues.

• Employ analytical skills to determine root causes and implement effective solutions.

• Safeguard the confidentiality of patient records and company information in accordance with HIPAA regulations.

• Maintain comprehensive and accurate records of claims that are processed, denied, or needing further investigation.

• Analyze and report trends in claim issues or irregularities to management.

• Assist Team Leads with reporting to support continuous process improvements.

• Participate in audits and compliance reviews to ensure adherence to both internal and external regulations.

• Critically assess and suggest process improvements when necessary.

• Mentor and train new claims processors as required.

⛳️ Requirements

• High school diploma or equivalent.

• At least five years of experience in medical claims processing, encompassing both professional and facility claims, along with complex and high-dollar claims.

• Familiarity with ICD-10, CPT, and HCPCS coding systems.

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

• Strong attention to detail and precision.

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

• Excellent written and verbal communication skills.

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

• Capability to work both independently and collaboratively within a team environment.

• Commitment to continuous education and staying updated with industry standards and technological advancements.

• Experience in claim denial resolution and the appeals process.

• Ability to efficiently manage a high volume of claims.

• Strong problem-solving skills and a customer service-oriented approach.

• Flexibility to adapt to the changing needs of the client and program modifications.

🏝️ Benefits

• 401(k) with employer matching

• Health insurance

• Dental insurance

• Vision insurance

• Life insurance

• Flexible Paid Time Off (PTO)

• Paid Holidays