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Lead Claims Processing Specialist
2 months ago
Key Responsibilities
- Oversee the identification and correction of claim adjustments for EDPS encounters prior to payment
- Formulate strategies to mitigate risks of overpayments and underpayments
- Direct the review program for high-value claims
- Address complex audit tasks to pinpoint inaccuracies in claim payments
- Engage with essential stakeholders to devise solutions for payment-related issues
- Bachelor's degree in a relevant discipline
- A minimum of 5 years of experience in claims processing
- Familiarity with bundled payment agreements or risk and capitation models
- Proficient in SQL and Microsoft Office Suite
- Understanding of medical terminology and billing practices
- Strong analytical capabilities and problem-solving aptitude
- Ability to thrive in a dynamic environment and effectively lead teams
- Certification as a Medical Reimbursement Specialist is preferred
- 401(k) retirement plan
- Comprehensive health insurance
- Generous paid time off
- Vision insurance coverage
- Full-time position, Monday to Friday, with occasional weekend requirements
Office-based role with occasional lifting involved.
Additional departmental responsibilities may be assigned.
