Healthcare Claims Specialist

Job Summary

A company is looking for a Healthcare Claims Specialist - REMOTE.

Key Responsibilities

• Review and process claims according to plan benefits and contractual reimbursement terms
• Audit auto-adjudicated claims and maintain desk top procedures related to claim adjudication
• Identify and communicate defects or issues within the claims system to management and coordinate problem-solving efforts

Required Qualifications, Training, and Education

• Minimum of 3 years' experience in medical claim adjudication or examination
• Knowledge of medical and insurance industry terminology, including CPT/ICD-10, HCPCS, and Revenue Codes
• Experience writing desk top procedures
• Prior experience with claim testing and/or auditing
• Certification as a Certified Coding Specialist (CCS) or Certified Coding Professional (CPC) is preferred