[Remote-Position] Claims Examiner (FULLY REMOTE - FLORIDA)
Role Snapshot:
- Start Date: Immediate openings available
- Position: Claims Examiner
- Location: Remote
- Company: Workwarp
- Compensation: a competitive salary
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The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements. Summary of Essential Duties and Responsibilities  Enter claim data accurately and timely, in alignment with departmental production and quality goals  Manually price and adjudicate claims as needed.  Maintain a minimum of 98% accuracy at all times  Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines  determination.  Ensure claims payments are made within time frames as reflected in contractual agreements  Identify and refer potential fraud and abuse cases to the Compliance Department  Other duties and responsibilities as may be assigned. Minimum Requirements  High School diploma or GED equivalent  Minimum of two years experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience  Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.  Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500)  Strong knowledge of medical terminology  Knowledge of CPT Codes and HCPCs codes  Knowledge of ICD-10 coding  HIPAA regulations  Medicaid and Medicare claim processing experience a plus  Ability to read and interpret general business correspondence, procedure manual, and specific plan document Abilities Required  Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames  Ability to read, write and communicate at a professional level  Effective time management and organizational skills  Effective interpersonal and communication skills Apply Job!Â
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