Claims Examiner
4 weeks ago
**Job Summary:**
We are seeking a highly skilled Claims Examiner to join our team at CommonSpirit Health. As a Claims Examiner, you will play a critical role in ensuring the accurate review, input, and adjudication of specialists, ancillary, and electronic claims in accordance with outside regulations, internal production standards, and contractual obligations of the organization.
Key Responsibilities- **Claims Review and Adjudication:**
- Responsible for the accurate review, input, and adjudication of specialists, ancillary, and electronic claims in accordance with outside regulations, internal production standards, and contractual obligations of the organization.
- **Claims Analysis:**
- Analyze claims data to identify trends, patterns, and areas for improvement.
- **Communication:**
- Communicate effectively with internal stakeholders, including physicians, nurses, and other healthcare professionals, to ensure accurate and timely claims processing.
- **Quality Assurance:**
- Ensure compliance with regulatory requirements and internal quality standards.
- **Education and Experience:**
- One or more years of experience working in a healthcare or related business environment.
- **Skills and Qualifications:**
- Ability to use general office equipment correctly and safely.
- Ability to maintain knowledge of and conform to company policies and procedures.
- Ability to maintain strict confidentiality at all times.
- Must be attentive to detail, accurate, thorough, and persistent in following through to completion of all activities.
- Knowledge of arithmetic, including ability to add, subtract, multiply, and divide whole and fractional numbers.
- Ability to read and comprehend written instructions and interpret numerical data.
- Good communication skills; able to read, write, and speak articulately, using established channels of communication.
- **Experience:**
- Six (6) months of experience as a Claims Examiner preferred.
- **Education:**
- Completion of vocational school program in medical billing and coding preferred.
- **Skills and Qualifications:**
- Experience in medical billing services and/or a managed care environment preferred.
- Knowledge of ICD-9, ICD-10, CPT-4, and HCPCS coding preferred.
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