Telecommute Bilingual CPT ICD9 and PMHS Claims Review Representative 3

Job is Expired

Location: Puerto Rico

Compensation: To Be Discussed

Staff Reviewed: Wed, Oct 27, 2021

Job Category: Insurance

Remote Level: 100% Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Some College, Bachelors

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

COMPLETE JOB DESCRIPTION

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