Job Summary: The Senior Claims Examiner is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as, ensuring compliance with federal regulations. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.
Roles & Responsibilities:
Meets expectations of the applicable One client's Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines
Minimum Qualifications:
Associate's degree or equivalent job-related experience required.
Minimum of 3 years' experience processing medical claims in the healthcare industry.
Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable.
Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc.
Numbers & Facts
Location
Irving, TX
Salary
$22.25 Per Hour
Skills
Analysis Skillsunmatched
Centers for Medicare and Medicaid Services (CMS)unmatched
Claims Processingunmatched
Desktop PCunmatched
Durable Medical Equipmentunmatched
Federal Compliance Regulationsunmatched
Healthcareunmatched
Healthcare Providersunmatched
Home Careunmatched
Insurance Claimsunmatched
Laboratory Equipmentunmatched
Maintain Complianceunmatched
Managed Careunmatched
Medical Recordsunmatched
Medicareunmatched
Microsoft Exchange Serverunmatched
Network Configuration Managementunmatched
Quality Assuranceunmatched
Regulatory Complianceunmatched
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