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Medical Claims Examiner

1 month ago

Ossining, United States Madison Approach Full time
Job DescriptionJob Description#zr
Position Title: Claims Examiner
Job Summary:We are seeking an organized and detail oriented self-starter with one to three years’ experience in medical claims processing for a full-time Claims Examiner position. This position will be responsible for the review and adjudication of medical, dental, vision, and prescription claims. This is a Temp to Permanent opportunity. The hours are Monday through Friday, 8:30am – 4:00pm. Location: Northern Westchester, NY This position is non-exempt with an hourly rate of $27.00 per hour.
Responsibilities:
  • Process claims for client's members including medical, dental, vision, and prescription.
  • Deal with complex claim issues, identifying root cause of problems
  • Understand and analyze insurance EOB’s to ensure maximum cost savings from plans.
  • Requests additional information for incomplete or unclean claims; follows up with provider as necessary.
  • Handle insurance enrollments as well Social Security and other government benefits.
  • Maintain database containing data on insurance, Social Security, and medical device coverage.
  • Supervise Claims Examiners in absence of Claims Supervisor and/or Director.
  • Audit claims processed by Claims Examiners and Claims Assistant.
  • Assist the Claims Supervisor and Director with all unit initiatives including but not limited to check runs, cost containment, and special projects.
Qualifications:
  • High school diploma or equivalent; some college preferred
  • A minimum of one to three years documented experience in medical claims processing
  • Must have thorough knowledge, compliance and understanding of HIPAA guidelines, ICD-10, CPT, ADA, HCPCS codes, medical terminology and familiarity with various health claims and forms including HCFA/CMS-1500, UB-04, and ADA forms.
  • Knowledge and understanding of various medical and prescription drug insurance plans including but not limited to Medicare, Medicaid, HMO’s, PPO’s, Government Plans and other plans is required.
  • Self-starter able to work in a highly accurate, independent and organized, efficient manner
  • Strong leadership, negotiation, communication and interpersonal skills; supervisory experience is a plus in support of Supervisor and Director.
  • Must have strong interpersonal, verbal and written communication skills in dealing with providers, facilities, insurance plans, and client Members, and providing superior customer service.