Job Summary

A health insurance company is seeking a Telecommute Bilingual CPT ICD9 and PMHS Claims Review Representative 3.

Candidates will be responsible for the following:

• Making appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation
• Participating in the pre-screening review process by applying guidance, and making an appropriate decision which may include interpretation of provider information or data
• Performing advanced administrative/customer support duties that require independent initiative and judgment

Qualifications Include:

• 2 years of experience reviewing and processing medical claims
• Prior experience with inventory management, financial administrative task or related experiences
• Prior experience utilizing CPT, PMHS and ICD9, ICD10 terminology
• Prior experience providing attention to detail and accuracy on reviewing medical claims
• Bilingual fluency in English and Spanish
• Ability to review all claims identified to have a potential overpayment opportunity