Overview
Ready for a career that excites you and has you up early, beating the alarm clock in the morning?
Joining ExamWorks as a Claims Analyst may be the best decision you ever make.
You will be responsible for determining 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 is 100% remote. Candidate must be available to work 8:00a-5:00p PST; Monday through Friday. Office equipment (office phone, screen, keyboard, mouse and virtual desktop) will be provided. In order to work remote you must have access to your own ISP with a router (both the phone and virtual desktop must be plugged in) and a dedicated “office space” where you can set up your work station with desk and chair.
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
- High school diploma or equivalent required.
- 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.
ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers’ compensation insurance coverages.
ExamWorks offers a fast-paced team atmosphere with competitive benefits, paid time off, and 401k.
