Experienced Healthcare Claims Processor-remote
About the position Responsibilities • Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. • Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios. • Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers. • Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions. • Uphold the confidentiality of patient records and company information as per HIPAA regulations. • Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability. • Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting. • Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes. • Mentors and trains new claims processors as needed. Requirements • High school diploma or equivalent. • Minimum of 5 years' experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims. • Familiarity with ICD-10, CPT, and HCPCS coding systems. • Understanding of medical terminology, healthcare services, and insurance procedures (worker's compensation experience is a plus). • Strong attention to detail and accuracy. • Ability to interpret insurance program policies and government regulations effectively. • Excellent written and verbal communication skills. • Proficient in Microsoft Office Suite (Word, Excel, Outlook). • Capacity to work independently as well as collaboratively within a team. • Commitment to ongoing education and training in industry standards and technology advancements. • Experience with claim denial resolution and the appeals process. • Ability to efficiently manage a high volume of claims. • Customer service-oriented with strong problem-solving capabilities. • Must be flexible and have the ability to adjust to the needs of the client and changes in the program. Benefits • $22-25/hour Apply tot his job Apply tot his job