HealthEdge razvija tehnologijo za zdravstvene zavarovalnice v okviru svojega paketa rešitev HealthRules Solutions Suite. Portfelj platforme zajema digitalno upravljanje zahtevkov, delovne tokove za upravljanje oskrbe in zagotavljanje celovitosti plačil. Zdravstvenim načrtom pomaga povezovati operativne podatke, avtomatizirati ključne procese, izboljšati natančnost plačil in podpirati boljšo izkušnjo članov. HealthEdge se osredotoča na zdravstvo in zdravstveno zavarovanje ter združuje strokovno znanje s področij programske opreme in svetovanja, da lahko zavarovalniške organizacije delujejo učinkoviteje in bolje usklajujejo oskrbo.
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.
Opis
- 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
Zahteve
- 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
Ugodnosti
- 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