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HealthEdge
HealthEdge
1.001 – 5.000 Angajați
Sponsor pentru viza H1BAsigurare de sănătateAsistență medicalăConsultanță
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.
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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.

USStatele Unite ale AmericiiRemoteNormă întreagăJuniorNu este necesară o diplomăLimbă Obligatorie: englezăSpecialist în daune

Descriere

  • 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

Cerințe

  • 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

Beneficii

  • 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

Locuri de muncă similare

Biogen

Senior Associate, Sales Force Effectiveness — Biogen, Madrid (Hybrid)

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5.001 – 10.000 Angajați
Sponsor pentru viza H1BAsistență medicalăBiotehnologieIndustria prelucrătoare
ESSpaniaHibridNormă întreagăSeniorLimbă Obligatorie: englezăLimbă Obligatorie: spaniolăVânzări

Support commercial excellence at Biogen by improving sales targets, incentives, CRM, analytics and omnichannel execution. The Madrid-based role focuses on field-force productivity and biotechnology medicines.

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