Claims Analyst

Overview

ExamWorks is looking for a highly motivated candidate to join our team as a *Remote* Claims Analyst. This person utilizes the system database to determine the reasonable cost of medical care and manually reviews for  application of proper fee schedule, accurate diagnosis and ICD/CPT coding, and duplicate billing in addition to other factors. This position ensures reviews are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements.

This is a full-time position with a standard Monday- Friday (8-5pm PST) schedule. 

This position will be 100% remote but candidate must work the Pacific Time Zone hours.

We do offer equipment for this position, however the candidate must have high speed Internet.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Processes claims by correctly identifying the billing type (physician, surgery center, hospital, etc) and entering medical bills into the reviewing system, allowing automated adjudication to process.
  • Receives client submissions and inputs client and examinee data in the system database.
  • Reviews each claim and addresses all necessary modifications manually.
  • Ensures all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
  • Processes client invoicing in accordance with the client’s fee schedule.

Qualifications

  • REQUIREMENTS:
    • Ability to work 100% remote.
      • Must work on the Pacific Time Zone.
      • Experience of remote work preferred.
    • High school diploma or equivalent required.
    • Must be a qualified typist with a minimum of 40 W.P.M.
    • High level of data entry accuracy.
    • Experience in a medical office or insurance industry with knowledge and experience utilizing ICD9, CPT coding and Medical Terminology preferred.
    • Must have moderate to high level of computer and multiple software programs competency, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
    • Must have a full understanding of claim adjudication for First & Third Party, Med Pay, No-Fault, Group Health, Workers Compensation, hospital claims and PPO.
    • Must have full understanding of the various types of medical billings and ability to identify which system database should be used.
    • Must be able to cross reference different types of billings to ensure consistency in the review process.
    • Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD-9 coding, bundling/unbundling and duplicate billing.

APPLY HERE