Medicare Claims Examiner II
综述 HealthEdge®为医疗保险公司提供人工智能驱动的运营基础设施，确保在日益竞争激烈的市场中持久的财务优势。我们正在经历强的市场动力，越来越多的健康计划选择了 HealthEdge 以现代化其业务并更有效地竞争。随着我们的扩张，我们正在投资推动这一增长的人类，这使得加入我们和塑造医疗保健技术未来的一个关键时刻。在 HealthEdge.com 了解更多信息。索赔审查员 II 负责通过特定的政策和程序来裁决医疗保健索赔。该角色负责审查索赔处理系统内的数据，确定是否提供服务是合适的以及满足福利覆盖标准。索赔检查员 II 负责审查裁定系统编辑以确定是否支付索赔和/或线条项 ((s).作为 HealthEdge 的索赔调查员 II,这是你有机会 ·根据客户规定的指导方针或团队领导指示对分配索赔进行处理的责任 ·负责管理层所设定的生产力目标，财务和程序准确性标准的实现·团队初级成员的导师 ·与其他团队成员合作于由团队领导分配的特殊项目；特别项目可能包括过程文件开发，培训，质量审计，协助客户升活动 （或任何其他由团队负责人确定的项目）·医生实践和医院编码，账单和医学术语，CPT,HCPCS 和 ICD-10,UB04,CMS1500,授权，医疗术语以及卫生保健概念等知识基础 · 建立和保持与管理层适当的沟通水平，以解决问题和关切，并采取预防措施确保处理精确性和质量 · 参加团队领导分配的项目；这些项目可能包括提供商数据，授权，注册或其他活动你带来：· 高中学位需要 · 1 3年医疗保健申请处理经验 · 坚实的理解和分析索赔数据的能力 · ICD-10 CPT 和 HCPCS 编码是一个加大因素 ·愿意学习新技能 ·团队合作者 ·强有力的工作道德 为此
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Overview
HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com.
HealthEdge is looking for Claims Examiner II, reporting to the Claims Team Leader. The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Claims Examiner II is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).
As a Claims Examiner II at HealthEdge, this is your opportunity to
- Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader
- Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management
- Mentor junior members of the team
- Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader
- Knowledge base around physician practices and hospital coding, billing and medical terminology, CPT, HCPCS, and ICD-10, UB04, CMS 1500, authorizations, medical terminology, and concepts of healthcare
- Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
- Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities
You bring:
- High School degree required
- 1 – 3 years healthcare claims processing experience
- Solid understanding and ability to analyse claim data
- ICD-10 CPT and HCPCS coding, is a plus
- Willingness to learn new skills
- Team collaborator
- Strong work ethic
For this role, we value:
- The ability to adapt quickly to a fast-paced environment
- A self-starter and quick learner
- Team player with an ability to collaborate
Geographic Responsibility: Remote, US
Type of Employment: Full-time, permanent
Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:
· The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
· Work across multiple time zones in a hybrid or remote work environment.
· Long periods of time sitting and/or standing in front of a computer using video technology.
· May require travel dependent on company needs.
The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.
HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.
Originally posted on Himalayas