Claims Examiner

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<div><strong>Benefits:</strong></div>
<ul>
<li>401(k)</li>
<li>401(k) matching</li>
<li>Dental insurance</li>
<li>Health insurance</li>
<li>Vision insurance</li>
<li>Wellness resources</li>
</ul>
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<strong>Summary<br></strong><br>
</div><div>The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.<br><br>
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<strong>Duties and Responsibilities<br></strong><br>
</div><div>· Accurately review all incoming Provider claims to verify necessary information is available.<br><br>
</div><ul><li>Meets production standards of 100-150 claims as established by claims management</li></ul><div>· Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.<br><br>
</div><div>· Coordinate resolution of claims issues with other Departments.<br><br>
</div><div>· Assist Providers, Members and other Departments in claims research.<br><br>
</div><div>· Provide backup for other examiners within the Department.<br><br>
</div><div>· Assist in training of new claims personnel.<br><br>
</div><div>· Promote a spirit of cooperation and understanding among all personnel.<br><br>
</div><div>· Attend organizational meetings as required<br><br>
</div><div>· Adhere to organizational policies and procedures.<br><br>
</div><div>· Performs other tasks as assigned by supervisor/manager<br><br>
</div><div>· Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration<br><br>
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<strong>Minimum Job Requirements<br></strong><br>
</div><div>High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.<br><br>
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<strong>Skill and Abilities<br></strong><br>
</div><div>· Experience in a managed care environment preferred.<br><br>
</div><div>· ICD-10 and CPT-4 coding knowledge preferred.<br><br>
</div><div>· Must be detail oriented and have the ability to work independently</div>
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<p>This is a remote position.</p>