Job Summary

A healthcare company is filling a position for a Telecommute Medicaid Claims Administrator.

Must be able to:

• Monitor prior authorization functions and assure that decisions are made in a consistent manner
• Ensure adoption and consistent application of appropriate inpatient and outpatient medical necessity criteria
• Monitor claims administration areas to identify and minimize the impact of irregularities

Qualifications Include:

• Minimum five (5) years of claims management experience
• Associates Degree in related field
• Familiarity with medical terminology and ICD-9/ICD-10, CPT, HCPCS
• Thorough understanding of claims adjudication processes required
• Proven analytical skills
• Excellent communication skills, both oral and written