Medicaid Claims Examiner II

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Adjudicate healthcare claims utilizing specific policies and procedures • Review data within the claims processing system to determine whether services rendered were appropriate and benefit coverage criteria were met • Review adjudication system edits to determine whether to pay claims and/or line items • Process assigned claims based on client-specified guidelines or team leader direction • Meet productivity targets and financial and procedural accuracy standards • Mentor junior team members • Collaborate on special projects, including process documentation, training, quality audits, and client surge activity • Maintain communication with management regarding issues and concerns • Take preventive measures to ensure processing accuracy and quality • Participate in projects involving provider data, authorizations, enrollment, or other activities

🎯 Requirements

• High School degree required • 1–3 years healthcare claims processing experience • Solid understanding and ability to analyse claim data • Knowledge of physician practices and hospital coding, billing, and medical terminology • Knowledge of CPT, HCPCS, and ICD-10 • Knowledge of UB04 and CMS 1500 • Knowledge of authorizations and healthcare concepts • ICD-10, CPT, and HCPCS coding is a plus • Willingness to learn new skills • Team collaborator • Strong work ethic • Ability to adapt quickly to a fast-paced environment • Self-starter and quick learner • Ability to collaborate as a team player • Ability to work across multiple time zones in a hybrid or remote work environment • Candidates may be required to undergo a pre-employment criminal background check

🏖️ Benefits

• Full-time, permanent employment • Remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity employer committed to workforce diversity