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.
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.
Descriere
- 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.
Cerințe
- 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.
Beneficii
- 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.