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.
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.
Tavsif
- 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.
Talablar
- 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.
Imtiyozlar
- 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.