Employer Industry: Business and Technology Services

Why consider this job opportunity:
- Hourly rate of $18.00
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere within the U.S.
- Supportive and collaborative work environment
- Chance to make a positive impact on provider relations and claims processing

What to Expect (Job Responsibilities):
- Review and investigate written dispute requests from providers related to denied or incorrect payments
- Interpret provider and health plan contracts to ensure accurate claims processing
- Adjust claims as necessary, including the calculation of interest and penalties
- Document each dispute accurately in the Provider Dispute Database for reporting purposes
- Communicate resolutions to providers in writing, adhering to departmental guidelines

What is Required (Qualifications):
- High school diploma or GED
- 3+ years of experience as a Claims Examiner with Medicare and HMO experience
- 2+ years of experience with medical terminology, including ICD9, ICD10, CPT4, HCPCs, UB04, and CMS 1500 Forms
- 2+ years of experience interpreting provider contract language and adhering to regulatory timeframes
- 1+ year of experience with Revenue and HCPCS coding practices

How to Stand Out (Preferred Qualifications):
- Experience with Xcelys Claims platform
- Previous auditing and appeals experience

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