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Medical Claims Examiner
2 months ago
Job Description
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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 EOBs 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, HMOs, PPOs, 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.
Company Description
We dont just want to find you a job, we want to help you achieve your goals. We do that with you, by listening to you. We take the time to discuss your needs, expectations and career objectives. We find out who you are as well as what you can do. And we call on our contacts in countless businesses and corporations to find the position that will fit your skills, your personality, and your potential.
We staff all levels of office staff, from entry-level clerical staff to organization management and everyone in between. We find employment opportunities for every vocation and aspiration from accountants to graphic designers, administrative assistants to IT professionals, purchasing managers to event planners, receptionists to directors.
If you are a permanent job seeker, well help you get your foot in the door and launch your dream career. Our experienced Talent Coordinators will advise you on everything you need to ace your interview, and negotiate the best possible salary and benefits package. Count on us to be advocates for you in your search.
Company DescriptionWe dont just want to find you a job, we want to help you achieve your goals. We do that with you, by listening to you. We take the time to discuss your needs, expectations and career objectives. We find out who you are as well as what you can do. And we call on our contacts in countless businesses and corporations to find the position that will fit your skills, your personality, and your potential. We staff all levels of office staff, from entry-level clerical staff to organization management and everyone in between. We find employment opportunities for every vocation and aspiration from accountants to graphic designers, administrative assistants to IT professionals, purchasing managers to event planners, receptionists to directors. If you are a permanent job seeker, well help you get your foot in the door and launch your dream career. Our experienced Talent Coordinators will advise you on everything you need to ace your interview, and negotiate the best possible salary and benefits package. Count on us to be advocates for you in your search.
