Claims Examiner

Date:  Jun 25, 2024

Location:  

Remote, Remote, US

Requisition ID:  9937

Description: 

A Claims Analyst in the Healthcare field processes medical claims by verifying and updating information about submitted claims and reviewing the work processes required to determine reimbursement. They would be responsible for providing billing analyses of claims and applying standards of federal regulations to ensure correct billing practices.

Shift Hours; 8am to 5 pm PST

Job Duties

Application of policy and provider contract provisions to determine if a claim is payable. If additional information is needed, or if a claim should be denied.

Determine the status of medical claims through research

Reviewing charges, and use of payment or denial codes within established guidelines and standards

Maintenance of records, files, and documentation

Meet the standards of department production and quality standards

Qualifications

High School diploma or GED

Health claims processing experience a plus

Knowledge in the following a plus:

medical terminology

ICD-9/ICS-10, CPT, and HCPCS coding

HIPAA regulations

PC applications and systems

Ability to read and interpret general business correspondence, procedure manuals, and specific plan documents

Basic mathematical skills

Intermediate typing skills

Multiple computer application usage experience

We are an Equal Opportunity Employer.  All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law.