„HealthEdge“ kuria technologijas sveikatos priežiūros paslaugų mokėtojams, naudodama savo „HealthRules Solutions Suite“ sprendimų rinkinį. Įmonės platformų portfelis apima skaitmeninį žalų administravimą, priežiūros valdymo procesus ir mokėjimų tikslumo užtikrinimą. Tai padeda sveikatos planams sujungti veiklos duomenis, automatizuoti pagrindinius procesus, pagerinti mokėjimų tikslumą ir užtikrinti geresnę narių patirtį. Daugiausia dėmesio sveikatos priežiūrai ir sveikatos draudimui skirianti „HealthEdge“ sujungia programinės įrangos bei konsultavimo kompetencijas, kad padėtų mokėtojų organizacijoms dirbti efektyviau ir geriau koordinuoti priežiūrą.
Remote Claims Examiner II — HealthEdge
Adjudicate healthcare claims for HealthEdge’s health insurance operations platform, reviewing coding, coverage criteria, and payment edits. The role also includes mentoring junior colleagues and contributing to quality and process projects.
Aprašymas
- Apply established policies and procedures to adjudicate healthcare claims.
- Assess claim system data to determine service appropriateness and whether benefit coverage criteria are met.
- Review adjudication edits and decide whether to pay claims or individual line items.
- Process assigned claims using client guidelines or directions from the team lead.
- Meet productivity goals and financial and procedural accuracy standards.
- Mentor junior team members.
- Support projects such as process documentation, training, quality audits, client surge work, and other assigned activities.
- Raise issues and concerns with management, and take steps to maintain processing accuracy and quality.
- Contribute to projects involving provider data, authorizations, enrollment, and related activities.
Reikalavimai
- High school diploma required.
- One to three years of healthcare claims processing experience.
- Sound understanding of claim data and ability to analyze it.
- Knowledge of 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 collaboratively as part of a team.
- May be required to complete a criminal background check before employment.
Privalumai
- Full-time, permanent employment.
- Remote work environment.
- Travel may be required based on company needs.
- Reasonable accommodations are available for individuals with disabilities.
- Equal opportunity employer committed to workforce diversity.