Claims Examiner

Intro:

Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you have claims adjudication or facility claims experience in healthcare? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:

Conducts claims payment analyses to identify root cause of claims issues/deficiencies.

Adjudicates medical claims

Verifies patient account, eligibility, benefits and authorizations.

Prioritizes assigned claims according to regulatory timelines.

Requests additional information for incomplete or unclean claims; follows up with provider as necessary.

Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes.

Corresponds with IPAs/Medical Groups regarding misdirected claims.