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Medical Claims Examiner

4 months ago

Aurora, United States Mastech Digital Full time

Below is the job description for your reference:


Position: Medical Claims Examiner

Location: 2500 S. Havana St. Arapahoe Aurora CO 80014 (Remote - should reside within 2.5 hours of Denver CO)

Duration: 3+ Months (High Possibility to extend / convert)

  • Should have minimum 3 years of claims processing experience. Only healthcare claims.
  • Remote for local candidates. Should be in a driving distance from Denver CO. Not more than 2.5 hours driving distance.

  • What are the typical day-to-day job duties of the Medical Claims Examiner/Processor?

Review medical claims that held with a pend or hold code and using our desk level procedures to apply appropriate guidelines for processing the claim. Usually these are duplicate holds, manual pricing required or determining if there is an authorization for the services.

  • Could you describe What technologies may this person interact with (ex: Outlook, TEAMS, SharePoint, EPIC, etc.)?

Outlook, TEAMS, SHAREPOINT, EPIC, Desk Level Procedures, Webstrat.

  • Aside from Claims experience, are there any other required/preferred skills that would help us identify the best fits for this role?

Claims experience is the primary skills needed for the positions.

• Required Level of Education and Preferred Level of Education: High School grad

• How many years of related experience are you looking for in your ideal candidate? 3 years Claims processing experience.

• Expected Shift: 8:00am-4:30pm

• Interview Process: Interview each candidate.

Required Education Level High School Diploma or General Education Development (GED) required.

Top Daily Responsibilities:

1. 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.

2.Ensures claims/bills meet eligibility, benefit, and Medicare requirements.

3. Utilizes knowledge of organizational policies and procedures to ensure adherence to contractual agreements and non-

contracted pricing arrangements along with compliance with government regulations.

Top (3) Required Skills Candidate Should Have:

1. Minimum 3 years of claims adjudication experience

2. Knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT).

3. Skills in analysis, interpretation and application of procedures, practices and methods used in claims adjudication without direct supervision or oversight.

Any specific system requirement or knowledge?

1.Basic PC skills

2. Working knowledge of Microsoft Word