What are the responsibilities and job description for the Claims Examiner I position at Cazador Consulting Group Inc?
Summary:
Under general supervision, the Claims Examiner I is responsible for reviewing, auditing, and processing medical and facility claims from both contracted and non-contracted providers. This role ensures that claims are processed accurately and in a timely manner, following established benefits, policies, and procedures.
Key Responsibilities:
- Review and process medical claims for accuracy and completeness.
- Resolve system-suspended claims for providers such as PCPs, labs, radiology, and physical therapy.
- Deny or adjust claims according to policy guidelines.
- Identify and report potential billing errors or fraudulent activity.
- Verify patient eligibility and coverage using online systems.
- Calculate and apply benefits manually when needed.
- Route complex claims to appropriate departments for review.
- Maintain production and quality standards.
- Perform other related duties as assigned.
Qualifications:
- High school diploma or equivalent required.
- Minimum of one (1) year of medical claims processing experience preferred.
- Knowledge of medical terminology, HCPCS, CPT, and ICD-10 coding.
- Familiarity with UB04 and CMS-1500 claim forms.
- Strong attention to detail, accuracy, and organizational skills.
- Ability to work independently and communicate effectively with internal teams and providers.
Job Types: Full-time, Temporary
Pay: $22.00 per hour
Work Location: In person
Salary : $22
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