Healthcare Claims Processor

Job not on LinkedIn

🕒 June 23

🐊 Florida, Maryland, +2 more states – Remote

🐊 Florida – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote 🤠 Texas – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Karna, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

🏛️ Government

Healthcare Insurance • Non-profit • Government

Karna, LLC is a public health consulting company that provides high-impact solutions to government, non-profit, and commercial organizations in the areas of science, research, technology, communications, and evaluation. As a member of the Celerian Group, a Blue Cross Blue Shield of South Carolina company, Karna leverages the capabilities of its sister companies to deliver tailored public health and clinical healthcare solutions. The company specializes in population health applications, health analytics, health communication, and public health research and support. Karna's expertise addresses complex issues in public health, such as mental health disparities, diversity, equity, and inclusion programs, and health outcomes evaluation. Their services include technical assistance, third-party administration, and training to improve strategic health goals across various sectors.

📋 Description

• Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. • Critical Analysis: Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios. • Timely Processing: Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers. • Issue Resolution: Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions. • Confidentiality Maintenance: Uphold the confidentiality of patient records and company information as per HIPAA regulations. • Detailed Record Keeping: Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability. • Trend Monitoring: Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting. • Audit Participation: Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes. • Mentoring: Mentors and trains new claims processors as needed.

🎯 Requirements

• High school diploma or equivalent. • Minimum of 5 years’ experience in processing medical professional and facility claims as well as complex and high-dollar claims. • Familiarity with ICD-10, CPT, and HCPCS coding systems. • Must have experience working with modifiers and bill types. • Understanding of medical terminology, healthcare services, and insurance procedures (worker’s compensation experience is a plus). • Strong attention to detail and accuracy. • Ability to interpret and apply insurance program policies and government regulations effectively. • Excellent written and verbal communication skills. • Proficient in Microsoft Office Suite (Word, Excel, Outlook). • Capacity to work independently as well as collaboratively within a team. • Commitment to ongoing education and training in industry standards and technology advancements. • Experience with claim denial resolution and the appeals process. • Ability to efficiently manage a high volume of claims. • Customer service-oriented with strong problem-solving capabilities. • Must be flexible and have the ability to adjust to the needs of the client and changes in the program.