Claims Examiner (FULLY REMOTE - FLORIDA)
The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements.
Summary of Essential Duties and Responsibilities
Β Enter claim data accurately and timely, in alignment with departmental production and quality goals
Β Manually price and adjudicate claims as needed.
Β Maintain a minimum of 98% accuracy at all times
Β Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines
Β determination.
Β Ensure claims payments are made within time frames as reflected in contractual agreements
Β Identify and refer potential fraud and abuse cases to the Compliance Department
Β Other duties and responsibilities as may be assigned.
Minimum Requirements
Β High School diploma or GED equivalent
Β Minimum of two yearsΒ experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience
Β Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.
Β Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500)
Β Strong knowledge of medical terminology
Β Knowledge of CPT Codes and HCPCs codes
Β Knowledge of ICD-10 coding
Β HIPAA regulations
Β Medicaid and Medicare claim processing experience a plus
Β Ability to read and interpret general business correspondence, procedure manual, and specific plan document
Abilities Required
Β Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
Β Ability to read, write and communicate at a professional level
Β Effective time management and organizational skills
Β Effective interpersonal and communication skills
Apply Now
Summary of Essential Duties and Responsibilities
Β Enter claim data accurately and timely, in alignment with departmental production and quality goals
Β Manually price and adjudicate claims as needed.
Β Maintain a minimum of 98% accuracy at all times
Β Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines
Β determination.
Β Ensure claims payments are made within time frames as reflected in contractual agreements
Β Identify and refer potential fraud and abuse cases to the Compliance Department
Β Other duties and responsibilities as may be assigned.
Minimum Requirements
Β High School diploma or GED equivalent
Β Minimum of two yearsΒ experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience
Β Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.
Β Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500)
Β Strong knowledge of medical terminology
Β Knowledge of CPT Codes and HCPCs codes
Β Knowledge of ICD-10 coding
Β HIPAA regulations
Β Medicaid and Medicare claim processing experience a plus
Β Ability to read and interpret general business correspondence, procedure manual, and specific plan document
Abilities Required
Β Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
Β Ability to read, write and communicate at a professional level
Β Effective time management and organizational skills
Β Effective interpersonal and communication skills
Apply Now