Healthcare (Medical) Claims Examiner - 1099 Contractor

Healthcare (Medical) Claims Examiner - 1099 Contractor

Smart Data Solutions (SDS) is a technology leader in healthcare process automation and interoperability. We are seeking an experienced Claims Examiner to partner with our rapidly growing Business Process Automation department as an independent contractor.

Working alongside SDS is both challenging and rewarding. With over 500 colleagues across the globe, we've created an open and honest culture where we value constant learning and new ideas - no matter what role you're in at SDS. We are passionate about our customers’ success and helping our colleagues grow and develop!

What will you be doing?

• Identifying, researching, processing and resolving claims/system edit pends according to desk level procedures (DLP), business guidelines, and quality standards.
• Meeting established productivity and timeliness standards to achieve individual and departmental performance goals as defined.
• Exhibiting capability of investigative and analytical research, demonstrating critical thinking and deductive reasoning
• Managing email proxy boxes and escalation emails as assigned.
• Consulting and coordinating with various teams/departments to obtain information to ensure proper and timely resolution of claims/system edit pends.
• Demonstrating a high level of flexibility and adaptability; remaining available to transition to different work groups based on business need.
• Employing strong organizational skills, making good use of work time, and demonstrating an ability to effectively use all available resources to meet established claims processing goals.
• Demonstrating and maintaining current working knowledge of the client’s systems, procedures, forms, and manuals as applicable.
• Utilizing your experience with multi-tasking and prioritizing.
• Adhering to all corporate and client mandatory training, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.
• Performing all other duties as assigned.

What are we looking for?

• Minimum: High School Diploma or equivalent
• Experience using current computer equipment and applications such as laptops and Microsoft Office Suite
• Proficiency with Ten Key and Typing skills.
• Ability to read and interpret Standard Operating Procedure documents and performance / production reporting.
• Intermediate level experience with MS Excel
• 3 years of experience reviewing and interpreting data on medical claim forms.
• Familiarity with medical claim forms CMS1500 and UB04
• Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers
• Ability to maintain confidentiality and privacy.

Preferred candidates possess:

• Knowledge of coordination of benefit (COB) principles and terminology.
• 3 year(s) of experience in Health Care claim operations
• Organizational skills and experience prioritizing project work and tasks.
• Experience in the health care industry working with Health Plans or Third-Party Administrators.
• Knowledge and understanding of government products and programs. (i.e. Medicare, Medicaid, etc.)

Who is Smart Data Solutions?

For over 20 years, Smart Data Solutions has been partnering with leading payer organizations to provide automation and technology solutions enabling data standardization and workflow automation. The company brings a comprehensive set of turn-key services to handle all claims and claims-related information regardless of format (paper, fax, electronic), digitizing and normalizing for seamless use by payer clients. Solutions include intelligent data capture, conversion and digitization, mailroom management, comprehensive clearinghouse services and proprietary workflow offerings. SDS’ headquarters are just outside of St. Paul, MN and leverages dedicated onshore and offshore resources as part of its service delivery model. The company counts over 420 healthcare organizations as clients, including multiple Blue Cross Blue Shield state plans, large regional health plans and leading independent TPAs, handling over 500 million transactions of varying types annually with a 98%+ customer retention rate. SDS has also invested meaningfully in automation and machine learning capabilities across its tech-enabled processes to drive scalability and greater internal operating efficiency while also improving client results.

SDS recently partnered with a leading growth-oriented investment firm, Parthenon Capital, to further accelerate expansion and product innovation.

Location: Smart Data Solutions is headquartered in Eagan, MN. This position has been approved for remote work. Candidates near our Dallas, TX location may be given preference and asked to work a hybrid schedule.

Internal code: BPA

Smart Data Solutions is an equal opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or other legally protected status

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge skill and or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform essential job functions.

Due to access to Protected Healthcare Information, employees in this role must be free of felony convictions on a background check report.