• Job Description

  Req#: 25-69894
  
  
  Job Description:
  • Medical Claims Processing - Accurately review, verify and process insurance claims following the company policies/SOPs.
  • Documentation Review - Analyze claim documents, medical records, benefit summary to determine claim eligibility and process the claim as per the benefit.
  • Customer and Internal Business Partner Interaction - Communicate with member, healthcare providers and internal business partners to resolve the claim or gather required additional information.
  • Data Entry - Enter claim details and maintain accurate records within the claims management system.
  • Continuous improvement - Identify process improvement opportunities to enhance claims accuracy and efficiency.
    
  • QNXT,MEDI-CAL
  
  CRITICAL SKILLS REQUIRED
  • Good working knowledge of computer i.e. MS office.
  • Excellent verbal & Written communication.
  • Good Interpersonal skills and should be able to work as a team player.
  • Expert knowledge of Health Care Domain with minimum experience of 5 years in Health care domain and claims processing.
  • Experience in Govt. Ops with experience of Medicare and Retirement / Medicaid claims processing.
  • Should able to explain the terms, Copay, Coinsurance, Deductible and out of pocket.
  • Should be able to describe Medicaid and Medicare eligibility in detail.
  • Excellent Communication Skills (Verbal & Written)
  • Should be good with basics of Computer.
  • Should have experience working as Claim Examiner Level III for minimum 3 years.
  • Should have experience working in Adjustment and Disputes (Appeals) for minimum 3 years.
  • Should have experience working on California Medicaid/Medicare claims.
  • Should be able to understand California claim's contract language.
  • Should have basic knowledge of Corrected claims processing.
  • Should have knowledge of CPT codes and HCPC codes.
  • Should have knowledge of UB04 & CMS1500 form.
  • Should have basic knowledge of Mathematical skills and should be able to problem solve claims calculations. (Benefi t/Out of Pocket)
  • Should be able to co-ordinate benefits with Medicare/Medicaid.
  
  
  
  
  
  Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
  

• About the company

  We provide Consulting Services for our customer’s project and staffing needs. We also provide Data Management for Clinical Trials.

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