HealthEdge
HealthEdge
HealthEdge HealthRules Solutions Suite арқылы денсаулық сақтау төлемдерін жүзеге асыратын ұйымдарға арналған технологияларды әзірлейді. Компанияның платформалар портфелі цифрлық талаптарды басқаруды, медициналық көмекті басқару жұмыс процестерін және төлемдердің дұрыстығын қамтиды. Ол денсаулық сақтау жоспарларына операциялық деректерді байланыстыруға, негізгі процестерді автоматтандыруға, төлем дәлдігін арттыруға және мүшелерге көрсетілетін қызмет тәжірибесін жақсартуға көмектеседі. Денсаулық сақтау мен медициналық сақтандыруға назар аудара отырып, HealthEdge сақтандыру ұйымдарына тиімдірек жұмыс істеуге және көмекті нәтижелі үйлестіруге жәрдемдесу үшін бағдарламалық жасақтама мен консалтинг саласындағы сараптаманы біріктіреді.

Remote Claims Examiner II – HealthEdge

At HealthEdge, the Claims Examiner II reviews and adjudicates healthcare claims, checking coding, coverage criteria, and system edits. The role also includes mentoring colleagues and contributing to quality and process projects.

Сипаттама

  • Process assigned healthcare claims using client guidelines and team direction.
  • Meet productivity targets and maintain financial and procedural accuracy.
  • Review processing data to assess service appropriateness and benefit coverage.
  • Evaluate adjudication system edits to determine payment for claims and line items.
  • Mentor junior team members.
  • Support projects such as process documentation, training, quality audits, and surge activity.
  • Communicate with management about issues and help maintain processing accuracy and quality.
  • Contribute to projects involving provider data, authorizations, enrollment, and other assigned work.

Талаптар

  • High school diploma required.
  • One to three years of healthcare claims processing experience.
  • Sound understanding of claim data and the ability to analyze it.
  • Familiarity with physician and hospital practices, coding, billing, and medical terminology.
  • Knowledge of CPT, HCPCS, ICD-10, UB-04, CMS-1500, and authorizations.
  • ICD-10, CPT, and HCPCS coding experience is a plus.
  • Willingness to learn new skills.
  • Collaborative approach to teamwork.
  • Strong work ethic.
  • Ability to adapt quickly in a fast-paced environment.
  • Self-motivated and quick to learn.
  • Ability to work effectively with a team.
  • May be required to complete a pre-employment criminal background check.
  • Ability to work across multiple time zones.
  • Ability to meet the physical demands of extended computer-based work, including sitting and/or standing and the required vision capabilities.

Артықшылықтар

  • Full-time, permanent position.
  • Remote work environment.
  • Hybrid or remote work environment.
  • Travel may be required depending on company needs.
  • Reasonable accommodations are available for individuals with disabilities in accordance with the Americans with Disabilities Act of 1990.
  • Equal opportunity employer committed to workforce diversity.

Ұқсас жұмыс орындары

Wallbit (YC W23)

Accountant, Argentine Tax and Compliance — Wallbit

Wallbit (YC W23)
11 – 50 Қызметкерлер
Банк ісіҚаржыФинтех

Advise Wallbit, a financial platform serving professionals paid by overseas companies, on Argentine accounting and tax matters. Manage compliance, invoicing, and automation initiatives.

Ашу
Job Duck

Billing and Collections Specialist

Job Duck
201 – 500 Қызметкерлер
КонсалтингҚұқықМаркетинг

Guide legal clients through payments, retainers, and trust accounts while supporting U.S. law firms with client education, complaint tracking, and accounts receivable management.

Ашу
Atlanta Beltline

Accounts Payable and Receivable Coordinator

Atlanta Beltline

Support Atlanta Beltline’s urban redevelopment work by coordinating payables and receivables. Manage invoices, billings, reconciliations, finance systems, and process improvements.

Ашу
Troutman Pepper
ShareHouse

Accountant, Fargo Hybrid

ShareHouse

Support financial reporting, reconciliations, and billing for ShareHouse’s addiction and mental health services. Manage EHR insurance payments, accounts receivable, audit support, and general ledger activities.

Ашу
Carle Health

Accounts Receivable Insurance Specialist (HB, PB & Denials)

Carle Health

Handle healthcare insurance claims, denials, appeals, and collections remotely. Support accurate reimbursement for Carle Health’s Illinois care network.

Ашу
Bon Secours Mercy Health

Revenue Cycle Manager, EMS Billing Operations

Bon Secours Mercy Health

Lead billing, collections, denial management, and compliance for Mercy Health’s Life Flight Network EMS services. Manage the billing team and improve revenue cycle performance.

Ашу
Breakthrough Blueprint

Remote Client Success Consultant

Breakthrough Blueprint

Support people exploring Breakthrough Blueprint’s personal development programs and virtual events. Manage digital follow-up independently with structured systems, training, and mentorship.

Ашу
BillingPlatform

Senior Customer Success Manager, BillingPlatform — Englewood Hybrid

BillingPlatform

Manage enterprise renewals, retention, and account expansion for BillingPlatform’s quote-to-cash SaaS customers. Build adoption and demonstrate measurable business value across a Colorado-based hybrid portfolio.

Ашу