Medical 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.

PayerFusion is seeking to hire an experienced claims processor, claims examiner to process hospital claims "UB-04" and physician claims collections "CMS 1500", claims adjudication, coding and claims coverage determination.

Responsibilities:

• Interpret, apply and comprehend policy terms, deductibles, coinsurance, copay and policy max
• Coding ICD 10, knowledge of how to process claims, how to read and interpret policies, CPT codes, Hospital coding and UB 04, Correct Coding Initiative principles.
• Responsible for searching the various PPO networks and direct contracts database to determine the appropriate network that a claim should be processed through in order to secure the greatest savings to ensure clients continue to benefit from PayerFusion cost containment efforts.
• Review and perform quality assessments of work being released to clients to ensure claims processing errors are kept at a minimum. Identify claims that should be audited by the Medical Team when the total charges exceed the pre-established PayerFusion criteria.
• Follow up on network pending claims to ensure that they are released meeting the deadlines.
• Handles Provider Statements/invoices by contacting the providers to request a complete
• Meets deadlines promised to clients for claims processing.
• Other office duties as assigned by Supervisor.

Requirements:

• Must have experience in medical claims processing and adjudication, self-motivated, responsible, and with a desire for advancement.
• Must have extensive knowledge of hospital and physician billing and collections, knowledge of Medicare, Medicaid, Commercial and PPO claims processing is a must.
• Must be proficient with the use of telephone in dealing with customers, providers and members.
• Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance.
• Fully computer literate in use of Microsoft Office Programs (Word, Excel, Outlook, Teams software).

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 such as 401K.