This is a remote position open to any qualified applicant in the United States.

Job Overview:
This position will be responsible for timely and accurate adjudication of professional and hospital claims using payer specific policies and procedures. You will provide support to claims and client for issues related to claims adjudication and adjustments, Service Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the employer’s Plan Document.

Review the data in the claim processing system, and comparing with corresponding UB or HCFA paper or EDI information.
Review medical records when necessary to determine if service rendered was medically appropriate and criteria has been met.
Review claim and line item edits and warning messages for determination of whether to pay claim/line item(s).
Ensuring all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs
Assigning special projects or other duties as determined by management.
Possess ability to work at a computer for extended periods.
A minimum of 1 years claims processing
High School degree or GED or equivalent experience.
Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9
Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims
Knowledge of Medicare billing & payment and coverage guidelines and regulations
Experience in the analysis and processing of claims, utilization review/quality assurance procedures
Must be able to work with minimal direction.
Creative thinker with good skills to resolve problems specifically related to healthcare claim adjudication
Will work closely with other departments
Cognizant will only consider applicants for this position whom are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.

Employee Status : Full Time Employee

Shift : Day Job

Travel : No

Job Posting : Apr 10 2023

About Cognizant

Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 185 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at or follow us @USJobsCognizant.
Applicants may be required to attend interviews in person or by video conference. In addition, candidates may be required to present their current state or government issued ID during each interview.

Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

If you have a disability that requires a reasonable accommodation to search for a job opening or submit an application, please email [email protected] with your request and contact information.

Be aware of fraudulent offers!!

Cognizant do not charge anything at any stage of the recruitment process and has not authorized any agencies or partners or individuals to charge any fee at any stage of the recruitment process. In case you receive offers that you suspect are fraudulent, please email us at [email protected]. By this, we want to avoid and prevent unaware prospective candidates from falling victim to these scams.

Kindly note that any payment made to either individuals or agencies for gaining employment at Cognizant, will be at your own risk & volition and Cognizant cannot be held accountable for the same.