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Medicaid Claims Examiner II
HealthEdge is seeking a Medicaid Claims Examiner II to adjudicate healthcare claims, assess coding and coverage criteria, review claim edits, and support junior examiners.
विवरण
- Adjudicate healthcare claims according to established policies and procedures
- Analyze claims system data to verify service appropriateness and benefit coverage
- Evaluate adjudication edits to determine payment decisions for claims and line items
- Process assigned claims under client guidelines or team leader direction
- Achieve productivity goals alongside financial and procedural accuracy standards
- Provide mentorship to junior team members
- Support special projects involving process documentation, training, quality audits, and client surge activity
- Keep management informed about issues and concerns
- Apply preventive controls to maintain processing accuracy and quality
- Contribute to projects involving provider data, authorizations, enrollment, and related activities
आवश्यकताएँ
- High school diploma required
- One to three years of healthcare claims processing experience
- Ability to analyze claims data effectively
- Understanding of physician and hospital coding, billing, and medical terminology
- Knowledge of CPT, HCPCS, and ICD-10
- Familiarity with UB-04 and CMS-1500 forms
- Knowledge of healthcare authorizations and related concepts
- Additional ICD-10, CPT, and HCPCS coding experience is a plus
- Willingness to develop new skills
- Collaborative approach to teamwork
- Strong work ethic
- Ability to adapt quickly in a fast-paced environment
- Self-motivated with the ability to learn quickly
- Ability to contribute effectively as a team player
- Ability to work across multiple time zones in a hybrid or remote environment
- Candidates may need to complete a pre-employment criminal background check
लाभ
- Full-time, permanent position
- Remote work environment
- Travel may be required based on company needs
- Reasonable accommodations available for individuals with disabilities
- Equal opportunity employer committed to workforce diversity
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