Medicare Claims Examiner II

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

📋 Description

• Process designated healthcare claims following client-specific guidelines or under the direction of the team leader.

• Achieve productivity goals while ensuring financial and procedural accuracy.

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

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

• Guide and mentor junior team members.

• Work collaboratively on special initiatives, including process documentation, training, quality audits, surge activities, provider data management, authorizations, and enrollment.

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

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

• Report directly to the Claims Team Leader.

⛳️ Requirements

• High School diploma is mandatory.

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

• Strong understanding and ability to analyze claim data effectively.

• Familiarity with physician practices as well as 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 advantageous.

• Eagerness to acquire new skills.

• Ability to work collaboratively within a team.

• Strong work ethic is required.

• Capability to adapt swiftly to a dynamic work environment.

• Self-motivated and quick to learn.

• Must be able to work effectively as a team player.

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

🏝️ Benefits

• Full-time, permanent position.

• Remote work setting.

• Operate across various time zones.

• Reasonable accommodations available for individuals with disabilities.

• Commitment to equal opportunity employment.

• Travel may be required based on company needs.