PayerFusion Holdings LLC Hiring for Healthcare Claims Examiner-Claims Processor at Coral Gables, FL Full Time

About Us

PayerFusion is a forward-thinking claims and payment solutions provider, utilizing cutting-edge technology and our unmatched industry expertise to bring complete transparency to the medical claims process. We have been uniquely positioned to streamline the healthcare process and create solutions that allow us to continually deliver superior service.

The Opportunity

We are seeking a Healthcare Claims Examiner-Claims Processor with experience to join our team. The ideal candidate should be knowledgeable about health care medical terminology and possess exceptional analytical, organizational, and problem-solving skills.

Job Responsibilities

• Review health care claim forms for completeness and accuracy in accordance with PayerFusion policies and procedures.
• Answer internal and external inquiries on claims, billing status, appeals, and quality assurance.
• Process claims using client-based applications.
• Apply knowledge of DAC and major insurance plans, Procedure codes, CPT Codes and ICD-9 and ICD-10 codes.
• Document claim data and decisions according to established policies and procedures.

Desired Qualifications

• 2+ years of medical claims processing/examining experience.
• Knowledge of medical terminology, CPT/HCPCS billing codes and ICD-9 and ICD-10 coding.
• Proficiency in MS Office.
• Detail-oriented, excellent organizational skills, and ability to multitask in a high-volume environment.
• Excellent customer service and communication skills.

Nice-to-Haves

• Experience with EDI and/or EDI mapper applications.
• Knowledge of relevant health care laws and regulations.
• Prior experience working at a PayerFusion.
• CPC or CPC-A certification.
• Prior experience with insurance follow-up and audits.

Perks

• We provide excellent health, dental insurances, Free vision insurance, Life insurance and 401K benefits.
• We also provide 10 days Paid Time Off and 12 Paid Holidays
• Great and pleasant working environment.
• Potential for remote or hybrid work