HealthEdge HealthRules Solutions Suite orqali tibbiy sug‘urta tashkilotlari uchun texnologiyalar ishlab chiqadi. Kompaniyaning platformalar portfeli raqamli da’volarni boshqarish, tibbiy yordamni boshqarish ish jarayonlari va to‘lovlar aniqligini qamrab oladi. Bu yechimlar tibbiy sug‘urta rejalari uchun operatsion ma’lumotlarni birlashtirish, asosiy jarayonlarni avtomatlashtirish, to‘lovlar aniqligini oshirish va a’zolar uchun yaxshiroq xizmat tajribasini ta’minlashga yordam beradi. Sog‘liqni saqlash va tibbiy sug‘urtaga e’tibor qaratadigan HealthEdge sug‘urta tashkilotlariga samaraliroq ishlash va tibbiy yordamni yanada yaxshi muvofiqlashtirishda ko‘maklashish uchun dasturiy ta’minot hamda konsalting tajribasini birlashtiradi.
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.
Tavsif
- 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
Talablar
- 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
Imtiyozlar
- 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