AddressDate: Mar 22, 2024
Location: Remote, Remote, US
Requisition ID: 8251
Description:
Medical Claims Examiner Responsibilities:
- Review and analyze medical claims to determine coverage and eligibility
- Investigate and gather information to support claim decisions
- Evaluate medical records, bills, and other documentation to ensure accuracy and compliance with coding standards
- Apply knowledge of medical terminology, coding systems (ICD-10, ICD-9), and billing procedures to process claims
- Communicate with healthcare providers, policyholders, and other parties to gather necessary information and resolve claim issues
- Make claim determinations based on policy guidelines and industry regulations
- Document claim decisions and maintain accurate records
Experience: - Previous experience as a Claims Adjuster or in a related role preferred
- Knowledge of medical office procedures, including medical coding and billing
- Familiarity with medical terminology, systems, and documentation
- Understanding of insurance policies, coverage, and claims processes
- Strong analytical skills with the ability to review and interpret complex medical records
- Excellent attention to detail and accuracy in claims processing
- Effective communication skills to interact with various stakeholders
Note: This job description is not intended to be all-inclusive. The employee may perform other related duties as negotiated to meet the ongoing needs of the organization
