Employer Industry: Healthcare Services

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 Referral Bonus Program
- Opportunity to work in a collaborative and supportive team environment
- Potential for career advancement within a growing organization

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 in claims processing
- Collaborate with delegated claim processors to review and correct errors prior to final payment
- Maintain production and quality standards as established by management
- Provide high-level customer service to internal and external customers while achieving quality and productivity goals

What is Required (Qualifications):
- Minimum of two (2) years’ experience with complex claims processing and/or auditing in the health insurance industry
- Two (2) years’ experience in a managed healthcare environment related to claims processing/audit
- Two (2) years’ experience with standard coding and reference materials, such as CPT4, ICD10, and HCPCS
- Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
- Strong knowledge of CMS requirements regarding claims processing, especially in skilled nursing facilities

How to Stand Out (Preferred Qualifications):
- Coding certification preferred
- Current experience with both Institutional and Professional claim payments
- Knowledge of automated claims processing systems

#HealthcareServices #ClaimsProcessing #CareerOpportunity #EmployeeBenefits #EqualOpportunityEmployer

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