Medical Claims Examiner
5 days ago
About PayerFusion
We are a leading service-based company and licensed third-party administrator, seeking top talent and experienced personnel to meet and exceed client expectations. Our innovative approach creates a unique experience for healthcare professionals.
Job Summary
We are looking for a highly qualified Claims Examiner for in-person on-site work with experience in the Commercial Health Insurance Industry.
Responsibilities
- Process hospital claims using UB-04 and physician claims collections using CMS 1500, with expertise in claims adjudication, coding, and coverage determination.
- Demonstrate extensive knowledge of hospital and physician billing and collections, including Commercial and PPO claims processing.
- Interpret, apply, and comprehend policy terms, deductibles, and coinsurance.
- Proficient in coding (ICD-9, ICD-10), claims processing, and policy interpretation, with excellent computer literacy in Microsoft programs (Word, Excel, Outlook).
- Experience with Medicare Advantage plans, capitation plans, risk assessment processes, and payments is a plus.
Requirements
- Must have experience in medical claims processing and adjudication, with a strong desire for advancement.
Benefits
- PayerFusion offers competitive compensation commencing with experience and industry knowledge.
- A comprehensive benefits package includes health, dental, vision, life, and supplemental insurance, 12 paid holidays, paid time off, and a 401(k) plan.
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