Claims Processing Specialist

2 weeks ago


Miami, Florida, United States PayerFusion Full time
Job Overview

About PayerFusion:

PayerFusion is a dynamic service-oriented organization, dedicated to providing exceptional solutions as a licensed third-party administrator. We pride ourselves on attracting top-tier talent and experienced professionals to consistently surpass our clients' expectations. Our innovative approach is reshaping the experience for healthcare practitioners, setting us apart from conventional industry solutions.

Key Responsibilities:

  • Proficiently process hospital claims using the "UB-04" format and manage physician claims collections via "CMS 1500", ensuring accurate claims adjudication, coding, and coverage determination.
  • Possess in-depth knowledge of hospital and physician billing practices, with a strong emphasis on Commercial and PPO claims processing. Familiarity with Medicare and Medicaid is advantageous.
  • Interpret and apply policy terms, including deductibles and coinsurance, with precision.
  • Demonstrate expertise in coding, including ICD-9 (ICD-10 knowledge is beneficial), and understand the intricacies of claims processing, policy interpretation, CPT codes, hospital coding, and UB-04 principles. Proficiency in Microsoft Office Suite (Word, Excel, Outlook) is essential, along with effective communication skills for interactions with customers, providers, and members.
  • Understand Medicare Advantage plans, capitation models, and the risk assessment process related to payments.

Qualifications:

  • Demonstrated experience in medical claims processing and adjudication is required. Candidates should be self-motivated, responsible, and eager for professional growth.

Employee Benefits:

  • Comprehensive health, dental, vision, life, and supplemental insurance options.
  • 12 paid holidays annually.
  • Generous paid time off policy.
  • 401K retirement plan.

Additional Perks:

  • PayerFusion offers competitive compensation based on experience and expertise in claims administration.
  • We provide a robust benefits package that includes vacation, holiday pay, sick leave, and health insurance, among other corporate benefits.


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