Medix Hiring for Remote – Claims Examiner Job at Remote Full Time

What is the Position?

Processes and adjudicates all (PCP) Primary Care Physician CMS 1500 claims in accordance with all claims policies, contracts, keeping in compliance with industry regulations and guidelines

Duties and Responsibilities

• Meets or exceeds claims standard of 95% or greater in the accuracy of claims processing, along with meeting or exceeding overpayment and underpayment standard of 98% or greater
• Meet or exceed the department standard of the production quota set by type of claim
• (30) Thirty claims per hour
• Adjudicate, and process PCP claims and apply all claims policies, contracts, practices, and keep in compliance with industry regulations and guidelines
• Must be able to work and make claims resolution with limited supervision
• Confirm eligibility for claim billed and date of service
• Comply with claims timeliness guidelines for PCP providers, no greater than a 90 day (TAT) Turn-around-time
• Complies with all Company and Department Policies and Procedures
• Knowledgeable with Federal and State requirements in claims processing
• Proficient in rate application for all CMS 1500 claims for all lines of business. (Medicare, Commercial, Medi-cal & Healthy Families)
• Ability to resolve claims issues on identified processing errors and make recommendations for improvements to avoid error
• Process and adjudicate claims in date received order. (First in, first out)
• Resolve any grievances and complaints received through Claims Customer Service Call Center Prompt and accurate response to claims related questions from Supervisors, and Management
• Identify any overpayments or underpayments in a review and or history search. Follow department protocol for reporting any overpayments or underpayments and follow-up
• Must be able to sit for lengthy periods of time, up to (3) three hours at a time
• Must be able to lift a maximum of 10 pounds
• Perform as required any task or assign

PREFERRED SKILLS

Previous experience processing Medicare claims

Qualifications

Has knowledge of CPT and ICD-9 codes, and medical terminology.
High school diploma or equivalent.
Excellent verbal and written communication skills.
Excellent organizational skills and interpersonal skills.
Experience with EZ-CAP system for claims processing.

Personal Qualities

Arrives daily to work on time.
Reports to work daily.
Ability to function and perform effectively under time constraints.
Ability to follow directions and multi-task.
Have a genuine willingness to accept responsibility and desire to learn new things.

Job Type: Contract

Salary: $20.00 per hour

Schedule:

• Day shift
• Monday to Friday

Application Question(s):

• How many years of experience do you have working as Claims Examiner?
• Are you a Certified Medical Coder?

Work Location: Remote