Claims Adjudicator // Remote // Must Live In Colorado

Job Description:

• Adjudicates medical claims/bills for payment or denial within contract agreement or guidelines/protocol, using knowledge of medical claim/bill payment processing and medical regulations. -- will go through the full process of the claim to evaluate and determine Kaiser's responsibility for the member benefits, member's liability, provider payment, and plan liability. Will be reviewing and interpreting contracts and working through EOBs and UB-04 forms
• Ensures claims/bills meet eligibility, benefit, and Medicare requirements. - working with EOBs
• Utilizes knowledge of organizational policies and procedures to ensure adherence to contractual agreements and non-contracted pricing arrangements along with compliance with government regulations

Qualifications:

• Minimum 3 years of claims adjudication experience within medical health - specifically paying the claim - must interpret contracts, understand EOBs to apply cost shares appropriately
• Strong understanding of UB-04 forms and EOBs (explanation of benefits)
• Knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT).
• Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.