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Medical Claim Professional

1 month ago

Miami, Florida, United States Secure Eclaims LLC Full time
About Secure Eclaims LLC

Secure Eclaims LLC is a leading benefits management company serving Puerto Rico and South Florida.

Job Overview

We are seeking a highly skilled Medical Claim Analyst to join our team. The selected candidate will be responsible for reviewing medical/surgical billings, examining coding of operative reports, and performing hospital length of stay reviews.

Responsibilities
  • Billing Review: Ensure accurate and reasonable billing by reviewing medical/surgical claims and identifying areas of potential discrepancy.
  • Coding Analysis: Evaluate the accuracy of coding in operative reports and procedures to ensure compliance with industry standards.
  • Hospital Length of Stay Reviews: Conduct thorough reviews of hospital stays to determine the appropriateness of care and identify opportunities for cost savings.
  • Claims Dispute Resolution: Collaborate with providers to resolve disputes related to billing and payment authorization.
  • Training and Development: Provide training and guidance to claims staff on quality healthcare cost containment and utilization reviews.
Requirements
  • Education: Bachelor's degree in Healthcare Administration, Health Informatics, or a related field.
  • Experience: Minimum 2 years of experience in medical claims review, auditing, or a related field.
  • Skills: Excellent analytical and problem-solving skills, strong attention to detail, and effective communication skills.
Benefits
  • Competitive Salary: $65,000 - $80,000 per year, depending on experience.
  • Opportunities for Advancement: Secure Eclaims LLC offers a dynamic work environment with opportunities for career growth and professional development.
  • Benefits Package: Comprehensive benefits package, including health insurance, retirement plan, and paid time off.
About Our Company

At Secure Eclaims LLC, we are committed to delivering high-quality, cost-effective care to our members while realizing substantial cost savings for payors. We strive to embody traditional values, promise reliability, and embrace flexibility and technology in our innovative care management model.