Claims Examiner (FULLY REMOTE - FLORIDA)
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 Now
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 Now