Claims Examiner
Job Summary
A company is looking for a Claims Examiner to ensure the financial integrity and efficiency of their healthcare organization.
Key Responsibilities
- Adjudicate a variety of claims and resolve system edits and audits
- Communicate with providers and members regarding claims, eligibility, and authorizations
- Assist in the review of stop loss reports and escalate potential system programming issues
Required Qualifications
- High school diploma or equivalent required
- 1-3 years of Medicare claims processing experience
- Knowledge of ICD-9, CPT, HCPC, and Revenue Coding
- Proficiency with claims processing software and technology
- Understanding of medical terminology, coding, and healthcare industry regulations
COMPLETE JOB DESCRIPTION
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