HealthEdge dezvoltă tehnologii pentru organizații care finanțează servicii de sănătate prin suita sa de soluții HealthRules. Portofoliul de platforme al companiei include administrarea digitală a dosarelor de despăgubire, fluxuri de lucru pentru gestionarea îngrijirii și integritatea plăților, ajutând planurile de sănătate să conecteze datele operaționale, să automatizeze procesele esențiale, să îmbunătățească acuratețea plăților și să susțină experiențe mai bune pentru membri. Cu un accent pe serviciile medicale și asigurările de sănătate, HealthEdge reunește expertiza în software și consultanță pentru a ajuta organizațiile care finanțează servicii de sănătate să lucreze mai eficient și să coordoneze îngrijirea într-un mod mai eficace.
Medicaid and Medicare Claims Examiner II
Review and adjudicate Medicaid and Medicare claims for HealthEdge, assessing coding, coverage, and payment decisions. The role also includes mentoring junior colleagues and supporting quality and process initiatives.
Descriere
- Process assigned healthcare claims under client guidelines or team-leader direction
- Assess claim data to verify service appropriateness and benefit coverage
- Review adjudication edits to determine whether claims and line items qualify for payment
- Meet productivity goals and financial and procedural accuracy standards
- Coach junior team members
- Support special projects such as process documentation, training, quality audits, and surge operations
- Keep management informed about issues and concerns
- Use preventive steps to maintain accurate, high-quality claims processing
- Contribute to projects involving provider data, authorizations, enrollment, or other assigned work
Cerințe
- High school diploma required
- One to three years of healthcare claims processing experience
- Ability to analyze claims data with a sound understanding of the information
- Familiarity with physician and hospital practices, coding, billing, and medical terminology
- Knowledge of CPT, HCPCS, ICD-10, UB-04, CMS-1500, authorizations, and healthcare concepts
- ICD-10, CPT, or HCPCS coding experience is an advantage
- Willingness to develop new skills
- Collaborative approach to working with a team
- Strong work ethic
- Able to adjust quickly in a fast-paced setting
- Self-directed and quick to learn
- Ability to work effectively as part of a team
- A pre-employment criminal background check may be required
Beneficii
- Full-time, permanent role
- Remote work arrangement
- Travel may be required depending on company needs
- Reasonable accommodations available for individuals with disabilities
- Equal opportunity employer with a commitment to workforce diversity