Medicare Claims Examiner II

🔥 5 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

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👻 Ghost score 10%

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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

• Process assigned healthcare claims according to client-specified guidelines or team leader direction • Meet productivity targets and financial and procedural accuracy standards • Review claims processing system data to determine whether services were appropriate and benefit coverage criteria were met • Review adjudication system edits to determine whether claims or line items should be paid • Mentor junior team members • Collaborate on special projects, including process documentation, training, quality audits, surge activity, provider data, authorizations, and enrollment • Maintain communication with management regarding issues and concerns • Take preventive measures to ensure processing accuracy and quality • Report to the Claims Team Leader

🎯 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, ICD-10, UB04, CMS 1500, and authorizations • ICD-10, CPT, and HCPCS coding is a plus • Willingness to learn new skills • Team collaboration ability • Strong work ethic • Ability to adapt quickly to a fast-paced environment • Self-starter and quick learner • Ability to collaborate as a team player • Candidates may be required to complete a pre-employment criminal background check

🏖️ Benefits

• Full-time, permanent employment • Remote work environment • Work across multiple time zones • Reasonable accommodations for individuals with disabilities • Equal opportunity employment • May require travel dependent on company needs