TISTA
Medical Claims Processing SME/EDI/CoE
4 days agoPayCompetitive
LocationRemote
Employment typeOther
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Job Description
- Req#: 5471
- Performs research on claim problems by utilizing approved policies, procedures, reference training materials, forms and coordinates with various internal support areas
- Corrects processing errors by reprocessing, adjusting, and/or recouping claims
- Ensures claims are processed according to established quality and production standards
- Assists the lead medical claims processor in training or mentoring new staff members
- Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints
- Use extensive knowledge and judgement to independently complete assignments consisting of numerous steps that vary in nature and sequence.
- Select from alternative methods and refer problems not solvable by adapting or interpreting substantive guides, manuals, or procedures.
- Verify medical claims and vouchers for accuracy and completeness in accordance with VA policy, Medicare regulations, and medical claims coding regulations and guidelines.
- Provide leadership and guidance to junior level staff.
- Train personnel on VA-FSC systems, if needed.
- 5+ years of experience processing medical claims and vouchers
- Possess thorough understanding of CPT, HCPCS, ICD-10-CM, and ICD-10-CM standards
- Working knowledge of MS Office, Access, and Excel
- Demonstrated success working in a team environment
- Knowledge of billing and follow-up regulations relating to Medicare
- Strong customer service skills
- In depth understanding of electronic claims editing and submission capabilities, including Medicare and NEIC online processing and query system
- Bachelor’s Degree in related field of study
- Ability to obtain Moderate Background Investigation (MBI) clearance
- Remote, USA
- The pay for this position ranges from $79,240 to $92,500
- The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location.
- Also, certain positions are eligible for additional forms of compensation, such as bonuses.
- TISTA associates are eligible to participate in our comprehensive benefits plan! More information can be found here: https://tistatech.com/working-at-tista/
Overview
TISTA Science and Technology is seeking to hire a Medical Claims Processing SME/EDI/CoE to join our growing team in Austin!
TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Tuition Reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more!
Responsibilities
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About the company
TISTA is a SDVOSB & 8(a) company based in Rockville MD that provides IT and professional services to Federal, State & Local, and Commercial Clients nationwide.