TISTA

Medical Claims Processing SME/EDI/CoE

4 days ago

PayCompetitive
LocationRemote
Employment typeOther

What's your preference?

Apply with job updates
  • Job Description

      Req#: 5471

      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

      • 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.

      Qualifications

      • 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

      Education:

      • Bachelor’s Degree in related field of study

      Clearance:

      • Ability to obtain Moderate Background Investigation (MBI) clearance

      Location:

      • Remote, USA

      Pay Range:

      • 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/
  • 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.