Medicare Claims Processor Jobs

ICD-9 and CPT coding and general practices of claims processing. Prefer knowledge of capitated managed care environment.

Major Functions (Duties and Responsibilities)

Major Functions (Duties and Responsibilities) Cont

Two (2) years experience in examining and processing medical claims; professional or institutional.

Medicare/Medi-Cal experience preferred. Claim adjustments, provider appeals and/or disputes preferred.

Microcomputer skills, proficiency in Windows applications preferred. Excellent communication and interpersonal skills, strong organizational skills.

2 years of experience processing, researching, and adjudicating claims

Strong organizational, analytical and judgment skills

Strong oral and written communication skills

5 years-of experience processing and adjudicating claims

CES, CORDS, OR AMMS experience

Knowledge of mathematical and statistical concepts

Keep alert to competitive products and marketing practices, and to keep management informed concerning them

Understand the covered benefits, non-covered benefits, exclusions and exemptions

Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product

Disclosures and provisions of the Advantage Medicare product

Develop a presence in the local community to help generate enrollments

Conduct home visits and personalized appointments as needed to complete the enrollment process

Keep alert to competitive products and marketing practices, and to keep management informed concerning them

Understand the covered benefits, non-covered benefits, exclusions and exemptions

Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product

Disclosures and provisions of the Advantage Medicare product

Develop a presence in the local community to help generate enrollments

Conduct home visits and personalized appointments as needed to complete the enrollment process

Exceptional organizational and time management skills

Bachelor’s degree or equivalent work experience

10 years of relevant work experience (12 years without bachelor’s degree)

SQL Server, Visual Basic skills preferred

Advanced to expert written and oral communication skills

Advanced analytical and problem solving skills

2 years of experience processing, researching, and adjudicating claims

Strong organizational, analytical and judgment skills

Strong oral and written communication skills

5 years-of experience processing and adjudicating claims

Knowledge of mathematical and statistical concepts

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

Upholds Kaiser Permanente's Policies and Procedures, Principles of Responsibilities, and applicable state, federal and local laws.

One (1) year relevant experience in health care industry.

Preferred experience with processing disability claims with EDD and release of Information processing.

This is a hybrid on-site/remote position processing Disability claims with EDD and fulfilling requests for Release of Information

Screens disability claims, interviews patients, locates and orders medical records.

Abstracts medical information and diagnoses using ICD-9 codes.

ACH background & Reg E Experience (In depth Reg E principal knowledge)

2+ years of Banking or financial experience (ideally experience managing claims in high pace environment)

Experience in a high volume environment dealing with claims and meeting defined metrics

Review any claims that are flagged and need to be reviewed or any claims that were not automated

Work with leads in the case issues come up that need to be approved

Stability/ longevity in previous roles

2 years of experience processing, researching, and adjudicating claims

Strong organizational, analytical and judgment skills

Strong oral and written communication skills

5 years-of experience processing and adjudicating claims

Knowledge of mathematical and statistical concepts

Examine and process complex or specialty claims according to business/contract regulations, internal standards and examining guidelines

Major Functions (Duties and Responsibilities)

Major Functions (Duties and Responsibilities) Cont

Three (3) years experience in adjudicating medical claims.

Microcomputer skills, proficiency in Windows applications preferred. Eexcellent communication and interpersonal skills, strong organizational skills required.

Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence.

A reasonable salary expectation is between $48,110.40 and $59,425.60, based upon experience and internal equity.

Continuing education funds for additional certifications and certification renewal.

Two years of experience processing, researching and adjudicating claims.

Strong organizational, analytical and judgment skills.

Strong oral and written communication skills.

Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.

High School Diploma or equivalent

Minimum Education and Experience Requirements:

College education may be substituted for experience.

Prefer some college-level business, finance or accounting courses.

Experience in Blue Cross, Medicare, Medicaid and/or other third-party payer billing or collections preferred.

Must have above average math skills and be proficient on a calculator.

Experience with computerized insurance billing system and Microsoft programs preferred.

Handle all correspondence via mail, email and any necessary refunds; perform other duties as assigned by management

Strong computer skills. Basic understanding of MS Outlook, Word and Excel.

Experience in an environment where calls were monitored and scored as well as metrics applied to individual performance is helpful.

Excellent communication skills, both written and verbal. Able to present information and solutions in a professional and courteous manner.

Shift M-F 830am-5pm EST. Fully Remote. Work from the comfort of your home.

Review claims that have been put on hold, working to identify causes and address issues causing them to remain on hold

Our Comprehensive Benefits Package Includes

401(k) retirement savings plan with company match

Fantastic health plans and free vision coverage

Paid annual leave — the longer you work here, the more you earn.

Onsite cafeterias and fitness centers in significant locations

Wellness programs and a healthy lifestyle premium discount

1-3 years of relevant work experience including claims submission/processing experience

Excellent verbal and written communication skills

Problem-solving skills to analyze, troubleshoot and resolve issues

Structured thinker and love checking things off your to-do list

An innovative spirit to push the boundaries

Ability to thrive in a fast-paced, results-oriented environment

1-3 years of relevant work experience including claims submission/processing experience

Excellent verbal and written communication skills

Problem-solving skills to analyze, troubleshoot and resolve issues

Structured thinker and love checking things off your to-do list

An innovative spirit to push the boundaries

Ability to thrive in a fast-paced, results-oriented environment

Review, process, and resolve moderately complex claims in accordance with contracts and policies.

Research claims through the utilization of reference materials and on-line tools.

Responsible for accurately coding claims through the system.

Translate data into information acceptable to the claims processing system including follow up on pended claims.

Maintain all appropriate claims files and perform follow-up on pended claims.

Prepare claims for return to Provider or Subscriber when additional information is needed.

Analytical, problem solving, retention of new knowledge, organizational skills.

1-2 years Moda Health claims processing experience preferred

Knowledge of medical terminology, HCPC codes, CPT codes and ICD-9/ICD-10 codes.

Demonstrated knowledge and understanding of plans processed by unit including complex claims and claims from various provider panels.

Effective written and verbal communication skills.

Performs manual calculation/override of benefit to enter correct information on claims the system cannot process.

Strong analytical, organizational and customer service skills.

Strong oral and written communication skills.

Proficient spelling, punctuation and grammar skills.

One year-of experience in a healthcare or insurance environment

Research and process claims according to business regulation, internal standards and processing guidelines

Verifies the coding of procedure and diagnosis codes