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Healthcare Claims Specialist - REMOTE

Evry Health

Role overview

Qualifications

  • Minimum of 3 years' medical claim adjudication/examination experience
  • Knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes
  • Strong attention to detail and problem-solving skills
  • Excellent communicator, both verbally and in writing

Responsibilities

  • Review and process claims within the claims transactional system according to plan benefits
  • Follow established policies to pay, pend, or deny claims
  • Accountable to meet department production and quality standards
  • Develop and maintain desk top procedures related to claim adjudication

Key facts

Hard skills

Adjudication Cppunit ICD 503 Salesforce Auditing

Other skills

  • Detail Oriented
  • Problem Solving
  • Microsoft Office
  • Communication
  • Teamwork
  • Time Management

About the company

Evry Health logo

Evry Health

Unknown

Company details

Company sizeUnknown

Links

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Job description


Roles and Responsibilities
  • Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms.
  • Follows established policies and procedures to pay, pend for additional information, or deny claims.
  • Process claims subject to Coordination of Benefits (COB) according to plan benefits, COB rules and contractual reimbursement terms
  • Accountable to meet and maintain established department production and quality standards.
  • Create claim test cases, execute, and report on the results.
  • Identify and communicate defects or claim system issues to those responsible for configuration.
  • Work with configuration to remediate and retest defects.
  • Identify and communicate inventory issues to department’s management.
  • Works with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner.
  • Develop and maintain desk top procedures related to claim adjudication.
  • Audit auto-adjudicated and/or manually processed claims.
  • Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins.

    • Experience and Skills Desired
  • You have a minimum of 3 years' medical claim adjudication/examination experience, working within a health insurance carrier, health insurance TPA, or equivalent.
  • You have knowledge of medical and insurance industry terminology including CPT/ICD-10, HCPCS and Revenue Codes.
  • You possess strong attention to detail and problem-solving skills with a high level of accuracy.
  • You have experience writing desk top procedures.
  • You are an excellent communicator, both verbally and in writing.
  • You can perform comfortably in a fast-paced, deadline-oriented work environment.
  • You are proficient in Microsoft Office applications Word, Excel, Outlook OneNote, etc.
  • You have prior experience using a CRM, preferably Salesforce.
  • You have prior experience with claim testing and or/auditing.
  • You collaborate and support business and operational units such as Customer Service, Medical Management and Appeals and Grievance.
  • Certified Coding Specialist (CCS) or Certified Coding Professional (CPC) preferred.
  • Bonus: Plexis/Quantum Choice experience.

    • Benefits Package
  • Competitive salary
  • Comprehensive health, dental, and vision insurance as well as life and disability
  • Retirement savings plan with company match
  • Generous time off/vacation
  • Professional development opportunities
  • Flexible work environment

    • Telecommuting Requirements
  • This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
  • Must live in the United States within the CST or EST time zones.
  • Company business hours are weekdays 9-5 CST.
  • Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
  • Ability to keep all company sensitive documents secure.
  • Must live in a location that receives an existing high-speed internet connection/service.
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    MR

    Marcus Rivera

    Chief Revenue Officer

    m.rivera@company.com
    linkedin.com/in/marcusrivera
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