Experienced Claims Analyst

2 weeks ago


Miami, Florida, United States PayerFusion Holdings LLC Full time
Job Overview

Company Overview:

PayerFusion Holdings LLC is a premier service organization dedicated to providing exceptional solutions as a licensed Third-Party Administrator. We are actively seeking talented and knowledgeable professionals who can exceed our clients' expectations. Our commitment to innovation ensures a unique experience for healthcare providers, distinguishing us within the sector.

Key Responsibilities:

  • Manage and evaluate claims processing and examination, including hospital and physician claims
  • Possess comprehensive expertise in hospital and physician billing, along with Medicare, Medicaid, and PPO claims oversight
  • Demonstrate proficiency in understanding policy details, including deductibles and coinsurance
  • Utilize skills in ICD coding, claims processing, CPT codes, and hospital coding
  • Maintain familiarity with Medicare Advantage plans, capitation strategies, and risk assessment methodologies

Qualifications:

  • Demonstrated experience in medical claims processing and adjudication
  • Self-driven with a strong desire for professional growth and accountability
  • Mandatory proficiency in Microsoft Excel

Employee Benefits:

  • Comprehensive health, dental, vision, life, and hospital gap insurance
  • Generous holiday leave and Paid Time Off
  • 401K plan with employer matching contributions

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