Our Client, an IT Services and Consultant company, is looking for a Claims Processer for their Des Moines location (will be working remotely but must be located in Iowa).
Responsibilities
Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
Documentation: Record claim activity, maintain audit trails, and prepare reports for management.
Requirements:
H.S. Diploma or equivalent
Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers)
2-4 years' experience in US healthcare claims processing
Familiarity with claims management software and EDI transactions