Temporary, Contractor, Full-time
Adjudication, Analysis Skills, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Communication Skills, Consulting, Correctional Health, Corrective Action, Current Procedural Terminology (CPT), Customer Relationship Management (CRM) Systems, Data Analysis, Demographics, Diversity, Documentation, Financial Analysis, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, High School Diploma, ICD-10, Information/Data Security (InfoSec), Medicaid, Medical Research, Medical Terminology, Medicare, Microsoft Excel, Multiplatform/Cross-Platform, Presentation/Verbal Skills, Reporting Skills, Salesforce.com, Writing Skills
Join a mission-driven healthcare organization dedicated to ensuring accurate claims processing and supporting equitable access to care. This role plays a key part in maintaining financial integrity by analyzing and correcting healthcare claim payments.
Responsibilities:
- Research and analyze medical claims adjustment requests to determine payment accuracy
- Adjust and adjudicate claims using multiple systems and platforms
- Apply appropriate payment guidelines including CMS, Medicare, Medicaid, and internal policies
- Investigate incorrectly processed claims and determine corrective actions
- Communicate findings and coordinate with internal stakeholders as needed
- Respond to provider inquiries regarding claim payments and required documentation
- Process claim adjustments within established timelines
- Maintain up-to-date knowledge of claims processing and coding updates
- Ensure accurate documentation and recordkeeping of all claims activity
- Generate reports and assist with audits as required
- Work independently and exercise sound judgment in decision-making
Qualifications:
- High School Diploma or equivalent required; Associate degree preferred
- Minimum 3 years of healthcare claims operations experience
- Strong understanding of claims adjudication processes
- Knowledge of medical terminology, CPT, ICD-10, and revenue codes
- Experience working with claims processing systems
- Familiarity with CRM systems such as Salesforce preferred
- Strong Excel and data analysis skills
- Excellent written and verbal communication skills
- Knowledge of HIPAA guidelines and protected health information
- Experience handling provider claim inquiries
"Please note that the salary range and/or hourly rate range of $20.00 - $30.00 is a good faith determination of potential base compensation offered to applicants at the time of this job advertisement and may be subject to modification in the future. When determining a team member's base salary and/or hourly rate, various factors may be taken into account as applicable (such as location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).
For consideration to this and/or other roles suitable for your background, please submit your most up-to-date resume to join our talent pool.
At ATRIA Consulting, LLC, we are a woman-owned business fully committed to promoting, cultivating, and maintaining a culture of diversity, equity, and inclusion. We embrace and celebrate differences across all demographics and backgrounds. We encourage everyone to apply."