Medical Claims Adjudicator

Vaga não está no LinkedIn

🕒 Julho 31

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

CanAide

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 1998

🏥 Saúde

☁️ SaaS

🤖 Inteligência Artificial

💰 Private equity em 2024-02

Healthcare • SaaS • Artificial Intelligence

A CanAide é uma empresa de tecnologia e automação voltada para a área de saúde, que oferece automação de processos robóticos com inteligência artificial, análises e serviços de suporte para otimizar a gestão do ciclo de receita, elegibilidade e inscrição de pacientes, e inscrição de deficientes para hospitais, sistemas de saúde e agências governamentais de saúde. Seus produtos incluem o CanAide IA (Automação Inteligente) e CanAide IDP (Prevenção Inteligente de Negativas), que utilizam RPA, IA e machine learning para reduzir a carga administrativa, prevenir negativas de reivindicações e melhorar o desempenho financeiro; a empresa destaca mais de 100 automações bem-sucedidas e reconhecimento pela gestão do ciclo de receita.

Descrição

• Analyze and review claims from various sources for accuracy and compliance with provider contracts • Prepare claim authorizations in coordination with client referrals • Estimate future claim costs for episodes of care using clinical information, past experience, and claim management software • Receive, process, and calculate claims payments while reviewing claim authorizations • Request and receive additional documentation from client representatives when necessary • Respond concisely and professionally to phone and email inquiries from client representatives • Investigate discrepancies and resolve them according to pricing rules and program requirements • Process claims for payment recommendation according to internal procedures • Review electronic claims and perform logging and data entry using medical bill repricing software and web-based tools • Conduct post-adjudication audits of claims as needed • Assist with compiling statistics for management reporting • Request and track the collection and storage of provider medical records as required by the program

🎯 Requisitos

• High school diploma or GED • 5+ years of experience • Strong working knowledge of Excel • General claims-handling knowledge • Strong written and verbal communication skills • Ability to review and analyze claims • Ability to work in a high-paced environment • Strong attention to detail • Exceptional knowledge of Medicare billing and reimbursement requirements • Strong understanding of federal HIPAA laws • Experience using medical claims payment and pricing systems • Exceptional analytical and problem-solving skills • Excellent organizational skills • Ability to meet deadlines, prioritize, and remain flexible • Ability to maintain focus despite interruptions • General knowledge of medical terminology and provision of medical services • Proficiency in Microsoft Office products, including Word, Excel, and PowerPoint • Ability to organize and analyze complex data and present it meaningfully • U.S. citizenship required • Billing and/or coding certification preferred • Ability to manage multiple tasks simultaneously • Ability to function successfully in a team environment • Ability to learn on the fly • Strong customer orientation • Self-starter able to work effectively with minimal supervision • Ability to function effectively in a rapidly changing work environment and work within unstructured settings

🏖️ Benefícios

• Medical insurance • Prescription drug coverage • Dental insurance • Vision insurance • Disability insurance • Retirement savings plan • Competitive paid time off program • Flexible benefits selection for employees and dependents • Collegial and supportive work environment • Teamwork, client focus, and fun culture