Adjudication, Adjudication Systems, Claims Processing, Contract Requirements, Current Procedural Terminology (CPT), Dental Insurance, Detail Oriented, Health Insurance, Health Plan, High School Diploma, ICD-10, Managed Care, Mathematics, Organizational Skills, Process Improvement, Process Management, Regulations, Staff Training, Vision Plan
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Vision insurance
- Wellness resources
Summary
The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.
Duties and Responsibilities
· Accurately review all incoming Provider claims to verify necessary information is available.
- Meets production standards of 100-150 claims as established by claims management
· Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
· Coordinate resolution of claims issues with other Departments.
· Assist Providers, Members and other Departments in claims research.
· Provide backup for other examiners within the Department.
· Assist in training of new claims personnel.
· Promote a spirit of cooperation and understanding among all personnel.
· Attend organizational meetings as required
· Adhere to organizational policies and procedures.
· Performs other tasks as assigned by supervisor/manager
· Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration
Minimum Job Requirements
High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.
Skill and Abilities
· Experience in a managed care environment preferred.
· ICD-10 and CPT-4 coding knowledge preferred.
· Must be detail oriented and have the ability to work independently
This is a remote position.