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Senior Claims Examiner

1 month ago

Miami, Florida, United States PayerFusion Holdings LLC Full time
About Us

PayerFusion Holdings LLC is a service-based company that excels in delivering innovative solutions to the healthcare industry.

We're seeking a top talent and experienced Claims Processor Specialist to join our team and help us meet and exceed our client's expectations.

Job Description

As a Claims Processor Specialist, you will be responsible for processing hospital claims and physician claims collections, as well as claims adjudication, coding, and claims coverage determination.

You will need to have extensive knowledge of hospital and physician billing and collections, as well as knowledge of Medicare, Medicaid, Commercial, and PPO claims processing.

You must be able to interpret, apply, and comprehend policy terms, deductibles, and coinsurance.

You will also be responsible for coding ICD 9 and ICD 10, as well as knowledge of how to process claims, read and interpret policies, CPT codes, Hospital coding, and UB 04.

Additionally, you will need to be proficient with the use of telephone in dealing with customers, providers, and members.

Responsibilities
  • Process hospital claims and physician claims collections
  • Claims adjudication, coding, and claims coverage determination
  • Interpret, apply, and comprehend policy terms, deductibles, and coinsurance
  • Coding ICD 9 and ICD 10
  • Knowledge of how to process claims, read and interpret policies, CPT codes, Hospital coding, and UB 04
  • Proficient with the use of telephone in dealing with customers, providers, and members
Requirements
  • Experience in medical claims processing and adjudication
  • Self-motivated and responsible
  • Desire for advancement
  • Knowledge of Microsoft Excel
Benefits
  • Excellent health and dental insurance coverage
  • Free vision, life, and hospital gap insurance
  • 12 paid holidays
  • Paid Time Off
  • 401K with company match up to 4%