Health Insurance Claims Examiner-Claims Processor

About Us:

We are a service-based company and as a licensed third party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.

Looking to hire a highly qualified Claims Examiner for in-person on site work. Must have experience in the Commercial Health Insurance Industry.

Responsibilities:

• Experienced claims processor, claims examiner to process hospital claims "UB-04" and physician claims collections "CMS 1500", claims adjudication, coding and claims coverage determination
• Must have extensive knowledge of hospital and physician billing and collections, knowledge of Commercial and PPO claims processing a must. Medicare, Medicaid experience optional and a plus.
• Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance
• Coding ICD 9 (ICD 10 helpful), knowledge of how to process claims, how to read and interpret policies, CPT codes, Hospital coding and UB 04, Correct Coding Initiative principles and must be fully computer literate in use of Microsoft programs (word, excel, outlook and other every day office support software. Must be proficient with the use of telephone in dealing with customers, providers and members
• Medicare Advantage plans, capitation plans,risk assessment process and payments

Requirements:

• Must have experience in medical claims processing and adjudication, self motivated, responsible, and with a desire for advancement.

Benefits

• Excellent health, dental, vision, life and supplemental benefits
• 12 paid Holidays
• Paid time off
• 401K plan

Bonus Points:

• PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry.
• PayerFusion provides competitive benefits that include vacation, holiday, sick-time as well as health insurance and other corporate benefits.