Hands-on experience processing medical claims end-to-end (adjudication expertise)
Proficiency in ICD-9/ICD-10 coding and Microsoft Outlook, Word, and Excel
Knowledge of healthcare terms including copay, coinsurance, deductibles, and out-of-pocket costs
Understanding of Medicare and Medicaid eligibility and claims processing
Requirements:
Review, verify, and process medical claims from start to finish, ensuring compliance with company policies and benefit guidelines
Evaluate claim documents, medical records, and benefit summaries to determine eligibility
Interact with members, providers, and internal teams to resolve issues and gather missing information
Enter claim details accurately into the claims system and maintain complete records
Job description
Job title: Claim Adjudicator Location: Tampa, FL (Remote after 8 Week Onsite Training) Duration: Full Time Salary: $19/Hr. + Benefits
Job Overview:-
Key Responsibilities
Claims Adjudication: Review, verify, and process medical claims from start to finish, ensuring compliance with company policies and benefit guidelines.
Documentation Analysis: Evaluate claim documents, medical records, and benefit summaries to determine eligibility.
Communication: Interact with members, providers, and internal teams to resolve issues and gather missing information.
Data Management: Enter claim details accurately into the claims system and maintain complete records.
Problem Resolution: Investigate discrepancies and resolve disputes promptly.
Adjustments: Handle rework and adjustments based on provider requests and internal requirements.
Required Skills & Experience
Adjudication Expertise: Must have hands-on experience processing claims end-to-end.
Technical Skills: ICD-9 & ICD-10 coding; proficiency in Outlook, Word, and Excel.
Healthcare Knowledge: Familiarity with copay, coinsurance, deductible, and out-of-pocket terms.
Government Programs: Understanding of Medicare and Medicaid eligibility and claims processing.
Preferred: Experience with CMS 1500 & UB forms; M\&R/Medicaid rework and adjustment claims.
Soft Skills: Excellent verbal and written communication; strong customer service orientation.
Diverse Lynx LLC is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company.
