Employer Industry: Health Insurance

Why consider this job opportunity:
- Affordable Medical/Dental/Vision insurance options
- Generous paid time-off program and paid holidays for full-time staff
- TeleMedicine 24/7/365 access to doctors
- Employee Assistance Plan (EAP)
- 401K retirement accounts
- Employee Referral Bonus Program

What to Expect (Job Responsibilities):
- Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
- Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
- Work closely with delegated claim processors to ensure errors are reviewed and corrected prior to final payment
- Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
- Escalate appropriate claims/audit issues to management as required

What is Required (Qualifications):
- Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical healthcare delivery system
- Two (2) years’ experience in a managed healthcare environment related to claims processing/audit
- Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10, and HCPCS
- Two (2) years’ experience with CMS requirements regarding claims processing, especially Skilled Nursing Facility and other complex claim processing rules and regulations
- Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans

How to Stand Out (Preferred Qualifications):
- Coding certification preferred

#HealthInsurance #ClaimsProcessing #CareerOpportunity #EmployeeBenefits #EqualOpportunityEmployer

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