Job Description

Medical Claims Examiner

The responsibilities of the Medical Claims Examiner consist of processing claims data and adjudicating medical and inpatient claims received from all provider types and lines of business, reviewing and resolving rejected and/or denied claims, conducting research and analysis of claims and facilitating resolution of specific claims issues. The Medical Claims Examiner is also responsible for monitoring copays, deductibles, insurance verification, and authorizations, analyzing incoming and outgoing revenue sources and measuring different financial cycles on behalf of EHR software customers, as well as maximizing reimbursements and developing effective policies for billing and claim processing. This position is 100% Onsite. There is no flex schedule for this opportunity, hours are from 8am-5pm. Must have experience in medical records, scanning and sending releases to other agencies.

Medical Claims Examiner Responsibilities:

- Submit claims and encounters in a timely manner.

- Review and resolve rejected, pended, and/or denied claims within expected timeframes.

- Coordinate claim adjustments with the customer.

- Identify revenue cycle issues and implement solutions to improve systems and processes.

- Respond to calls on claims issues and provide information and resolution in a timely manner.

- Provide education and technical support to Claims Examiners and customers regarding claims-related issues through on-line training and in person training.

- Produce scheduled reports for leadership and customers.

- Prepare written inter-departmental and external correspondence.

- Develop and publish formal written guidance for customers to process claims.

- Analyze encounter-processing data using statistical methodologies.

- Update and maintain electronic billing manual and distribute updates as directed.

- Compare business operations and coordinate technical analysis support for upcoming collection of accounts.

Qualifications

Medical Claims Examiner Qualifications:

- High School diploma or GED plus five (5) years full-time data entry experience in claims processing, accounting, analysis and adjudication of Medical and/or Behavioral environment.

- Must have experience in medical records, scanning and sending releases to other agencies.

- Excellent communication skills with coworkers and patients.

- Medical claims experience.

- Experience in Insurance verification.

- Medical records experience.

- Patient pay and collections experience.

- Insurance Payment review experience.

- Claims submission and billing experience.

- Experience with ICD10, CPT, HCPCS, and Inpatient coding and billing and knowledge of HIPAA regulations.

- Knowledge of Microsoft Excel and 10-key by touch.

- Knowledge of and experience working with Electronic Health Records system(s).

- Ability to translate customer needs to technical and/or business process solutions.

- Ability to effectively work with internal teams across numerous functions and levels.

- Ability to quickly learn complex business processes and understand the underlying transactional systems.

- Strong customer service skills and abilities.

- Exceptional communication skills, including strong customer-facing presentation and facilitation skills.

- Ability to work on multiple projects.

- Strong attention to detail and follow-through skills.

- Experience working in a team-oriented, collaborative environment.

- Strong analytical and problem-solving abilities.

- Comply with all policies, procedures and contractual/regulatory requirements.

- Within one month of hire, complete new-employee orientation.

- Complete and provide all training as directed.

- Provide documentation related to formal education, training, and compliance with general and physical requirements as requested.

- Demonstrate ethical behavior.

- Demonstrate dependability by reporting to work on-time and working required hours/days.

- Achieve monthly goals developed with the supervisor.

- Able to speak, read and write in both English and Spanish is a big plus.

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Additional Information

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