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Claims Processing Specialist
2 months ago
Position Overview:
PayerFusion Holdings LLC is a premier service-oriented organization dedicated to delivering exceptional administrative solutions in the healthcare sector. As a licensed third-party administrator, we pride ourselves on attracting only the most skilled and experienced professionals to ensure we consistently surpass our clients' expectations. Our innovative strategies provide a distinctive experience for healthcare practitioners, setting us apart from conventional industry solutions.
Key Responsibilities:
- Perform thorough processing of hospital claims using the "UB-04" format and physician claims utilizing the "CMS 1500" format, including claims adjudication, coding, and determination of claims coverage.
- Possess comprehensive knowledge of hospital and physician billing practices, with a strong emphasis on Commercial and PPO claims processing. Familiarity with Medicare and Medicaid is advantageous.
- Effectively interpret, apply, and understand policy terms, including deductibles and coinsurance.
- Demonstrate proficiency in coding ICD-9 (ICD-10 knowledge is beneficial), understanding claims processing, policy interpretation, CPT codes, hospital coding, and UB-04, while adhering to Correct Coding Initiative principles. Must be adept in using Microsoft Office applications (Word, Excel, Outlook) and possess strong telephone communication skills for interactions with customers, providers, and members.
- Engage with Medicare Advantage plans, capitation plans, and risk assessment processes related to payments.
Qualifications:
- Proven experience in medical claims processing and adjudication, demonstrating self-motivation, accountability, and a commitment to professional growth.
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 packages based on experience and expertise in the claims administration field.
- Our benefits package includes vacation time, holiday pay, sick leave, and health insurance, along with other corporate benefits.
