Healthcare Claims Processor Bakinaw
RemoteUnited States
Job Summary
Analyze and process complex medical claims in accordance with program policies, ensuring accuracy and compliance. Adjudicate claims using critical thinking to navigate high-dollar scenarios and resolve discrepancies by collaborating with departments to identify root causes. Uphold HIPAA confidentiality while maintaining thorough records of processed, denied, or investigated claims. Monitor trends in claim issues to assist with reporting and process improvements, and participate in audits to ensure regulatory adherence. Mentor new processors and apply experience with ICD-10, CPT, and HCPCS coding systems to manage a high volume of claims efficiently.
Required Qualifications
- 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
- Must have experience working with modifiers and bill types
- Understanding of medical terminology, healthcare services, and insurance procedures
- Strong attention to detail and accuracy
- Ability to interpret and apply 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
- High school diploma or equivalent
- Candidates must be located in one of the following states: FL, GA MD, MI, TX
Desired Qualifications
- worker's compensation experience
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.