Job Description Intro: Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you have claims adjudication or facility claims experience in healthcare? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you! Responsibilities Conducts claims payment analyses to identify root cause of claims issues/deficiencies. Adjudicates medical claims Verifies patient account, eligibility, benefits and authorizations. Prioritizes assigned claims according to regulatory timelines. Requests additional information for incomplete or unclean claims; follows up with provider as necessary. Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes. Corresponds with IPAs/Medical Groups regarding misdirected claims. Qualifications Requirements: 2-5 years medical claims examining experience, Minimum typing speed of 45 WPM and use of Ten-Key by touch Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements Additional Information If you are interested, PLEASE CONTACT Tyler AT 407-478-0332 EXT 117 #J-18808-Ljbffr
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