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Senior Medical Claims Examiner

Macpower Digital Assets Edge LLC

Irving, TX

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Analysis Skills, Centers for Medicare and Medicaid Services (CMS), Claims Processing, Desktop PC, Durable Medical Equipment, Federal Compliance Regulations, Healthcare, Healthcare Providers, Home Care, Insurance Claims, Laboratory Equipment, Maintain Compliance, Managed Care, Medical Records, Medicare, Microsoft Exchange Server, Network Configuration Management, Quality Assurance, Regulatory Compliance
LOCATION
Irving, TX
POSTED
30+ days ago
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.

About the Company

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Macpower Digital Assets Edge LLC

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