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Job Description
- Req#: 93048
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Competitive salary up to $80,000 per year
- Opportunity for career advancement and growth within the organization
- Comprehensive benefits package including health insurance and retirement plans
- Chance to work remotely and maintain a healthy work-life balance
- Supportive and collaborative work environment
- Unique opportunity to make a positive impact on the organization's mission
What to Expect (Job Responsibilities):
- Review claims for compliance with plan guidelines and approve or deny payment
- Document claims adjudication decisions clearly and concisely
- Coordinate adjudication of claims against individual enrollee eligibility and benefit verification
- Identify processes and system problems for improvement to reduce rework
- Maintain timely responses to appeals and reconsideration requests
What is Required (Qualifications):
- 3-5 years of experience in claims adjudication, including PPO and/or Medicaid, ERISA, Medicare, Level Funded, and Self-Funded
- Excellent working knowledge of MS Access, Google Sheets, and Excel
- Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding
- Experience processing claims on the HealthEdge System is preferred
- High school diploma or equivalent
How to Stand Out (Preferred Qualifications):
- Certification in claims adjudication or related field
- Experience with various claim payment systems in processing hospital, mental health, dental, and routine medical claims
- Strong analytical skills and attention to detail
#HealthcareServices #ClaimsAnalyst #CareerOpportunity #RemoteWork #CompetitivePay
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