Claims Examiner (FULLY REMOTE - FLORIDA)
The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements. Summary of Essential Duties and Responsibilities Enter claim data accurately and timely, in alignment with departmental production and quality goals Manually price and adjudicate claims as needed. Maintain a minimum of 98% accuracy at all times Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines determination. Ensure claims payments are made within time frames as reflected in contractual agreements Identify and refer potential fraud and abuse cases to the Compliance Department Other duties and responsibilities as may be assigned. Minimum Requirements High School diploma or GED equivalent Minimum of two years experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel. Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500) Strong knowledge of medical terminology Knowledge of CPT Codes and HCPCs codes Knowledge of ICD-10 coding HIPAA regulations Medicaid and Medicare claim processing experience a plus Ability to read and interpret general business correspondence, procedure manual, and specific plan document Abilities Required Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames Ability to read, write and communicate at a professional level Effective time management and organizational skills Effective interpersonal and communication skills Apply Job!