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Claims Processing Specialist
3 weeks ago
Job Title: Medical Claims Examiner
PayerFusion is seeking an experienced Claims Examiner for in-person on-site work with a background in the Commercial Health Insurance Industry.
Responsibilities and Qualifications
- 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.
- Proficient in coding (ICD-9, ICD-10), claims processing, and policy interpretation, with excellent computer literacy in Microsoft programs.
- Experience with Medicare Advantage plans, capitation plans, risk assessment processes, and payments is a plus.
- Excellent communication and customer service skills, with ability to interpret and communicate complex information effectively.
Benefits Package
- Competitive salary based on experience and industry knowledge.
- Comprehensive benefits package, including health, dental, vision, life, and supplemental insurance, 12 paid holidays, paid time off, and a 401(k) plan.