索赔处理员
Claims Processor
Raventra Health是一家医疗服务平台，为医疗机构和医院提供外包的账单、编码和理赔处理解决方案。作为理赔处理员，您将审核和处理医疗理赔，确保其准确、完整，并按照付款方的要求提交。您将与账单和编码团队密切合作，识别差异，解决常规问题，并帮助确保理赔处理高效准确。
WHAT YOU WILL DO
- 按照付款方要求和既定流程审核和处理医疗理赔
- 在提交前验证理赔信息的准确性、完整性和一致性
- 准确且一致地应用付款方特定的要求和账单指南
- 识别需要额外文件、更正或审核的理赔，并根据需要升级处理
- 在既定指南内解决常规的理赔差异和错误
- 与账单和编码团队合作，调查和解决相关理赔问题
- 保持处理过的理赔记录准确，并遵循既定的文档流程
- 在保持高准确率的同时满足生产率和质量标准
WHAT WE ARE LOOKING FOR
- 1年以上医疗理赔处理、医疗账单或相关收入周期岗位的工作经验
- 熟悉CMS-1500和UB-04理赔表格
- 了解基本的医疗账单术语和付款方要求
- 使用过理赔处理、账单或诊所管理系统的经验
- 强烈的细节关注能力和识别理赔信息差异的能力
- 在保持准确率的同时处理大量工作并按时完成任务的能力
- 良好的沟通和解决问题的能力
- 符合HIPAA规定的私人工作空间，能够有效进行全远程工作
NICE TO HAVE
- 与多家保险公司合作的经验
- 医疗编码知识或经验
- 处理理赔更正、拒付或申诉的经验
- 熟悉电子理赔提交系统
- 在医疗机构或医院工作的经验
COMPENSATION AND BENEFITS
薪酬将在面试期间讨论，将反映候选人的经验、资格和相关的医疗收入周期专业知识。
福利和其他雇佣详情将在招聘过程中讨论。
HIRING PROCESS
申请审核 → 初步沟通
查看英文原文
Raventra Health is a medical services company providing outsourced billing, coding, and claims processing solutions for provider groups and hospitals. As a Claims Processor, you will review and process healthcare claims to ensure they are accurate, complete, and submitted according to payer requirements. You will work closely with billing and coding teams to identify discrepancies, resolve routine issues, and help ensure claims are processed efficiently and accurately.
WHAT YOU WILL DO
- Review and process healthcare claims in accordance with payer requirements and established procedures
- Verify claim information for accuracy, completeness, and consistency before submission
- Apply payer-specific requirements and billing guidelines accurately and consistently
- Identify claims requiring additional documentation, correction, or review and escalate as appropriate
- Resolve routine claim discrepancies and errors within established guidelines
- Work with billing and coding teams to investigate and resolve claim-related issues
- Maintain accurate records of processed claims and follow established documentation procedures
- Meet productivity and quality standards while maintaining a high level of accuracy
WHAT WE ARE LOOKING FOR
- 1+ year of experience in medical claims processing, healthcare billing, or a related revenue cycle role
- Working knowledge of CMS-1500 and UB-04 claim forms
- Understanding of basic medical billing terminology and payer requirements
- Experience with a claims processing, billing, or practice management system
- Strong attention to detail and ability to identify discrepancies in claim information
- Ability to manage high-volume work while maintaining accuracy and meeting deadlines
- Strong communication and problem-solving skills
- HIPAA-compliant private workspace and ability to work effectively in a fully remote role
NICE TO HAVE
- Experience working with multiple insurance payers
- Medical coding knowledge or experience
- Experience with claim corrections, denials, or appeals
- Familiarity with electronic claims submission systems
- Experience working with provider groups or hospitals
COMPENSATION AND BENEFITS
Compensation will be discussed during the interview and will reflect the candidate’s experience, qualifications, and relevant healthcare revenue cycle expertise.
Benefits and additional employment details will be discussed during the hiring process.
HIRING PROCESS
Application review → introductory conversation → practical assessment → hiring manager interview → offer.
EQUAL OPPORTUNITY
Raventra Health is an equal opportunity employer. We consider all qualified applicants without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic. If you need an accommodation at any stage of the hiring process, please contact us and we will work with you to provide appropriate support.
Location: Remote
Originally posted on Himalayas