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Claims Examiner
- Job Title
- Claims Examiner
- Job ID
- 816964
- Begin Date
- 8/22/14
- Duration
- Location
- Miramar, FL
- Other Location
- Description
-
Claims ExaminerSource2 is looking for well qualified Claims Examiners in the Miramar, FL area! This is a great career opportunity to work with in the growing healthcare industry!
JOB SUMMARY:
The Claims Examiner is responsible for the accurate and timely processing of claims per regulatory and contractual guidelines. Examiner will process claims for all healthcare line of businesses reviewing complex claims, Coordination of Benefits, medical coding, and authorization payment allocation.
ESSENTIAL FUNCTIONS- Responsible for accurate and timely filing adjudication of claims according to state and federal regulations
- Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits
- Process both professional (CMS 1500) and institutional (UB-04) claim types
- Reconciliation of historical paid data and provider A/R
- Maintain quality and productivity standards as set by management
- Knowledge of HIPAA Privacy Rules
- Resolve provider network claims inquiries and apply resolution in a timely fashion
- Audits claims entry process for quality assurance
- Other duties as assigned by management
QUALIFICATIONSMinimum Qualifications - Minimum High School Diploma or GED equivalence
- 2-3 years’ experience processing Medicare and Medicaid claims
- Extensive knowledge of medical terminology with thorough comprehension in the usage of HCPCS, Revenue, and ICD-9 codes
- Interpretation and administration of Coordination of Benefits and it’s reimbursement structure
- Thorough knowledge in the review of healthcare claims denials in association to authorization, coding, eligibility, and timely filing rules
- Experience in gathering all necessary documentation in preparation for Managed Care audits
- Broad comprehension of state and federal prompt pay guidelines
- Knowledge interpreting state and federal reimbursement allowable along with their maximum limits
- Must be proficient in Microsoft environment, with intermediary level in Excel, Word, and SharePoint
- Exceptional Customer Service and organizational skills
- Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required
Preferred Qualifications - Knowledge of CareVoyant claims paying system
- Knowledge of PaySetter billing software
- Knowledge of MedTrac delivery software
- Knowledge of Lotus Note, scheduling module
Must be able to successfully pass a background and drug screening.
- Openings
- 1
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Univita Health is an Equal Opportunity Employer (EOE/AA) and participates in E-Verify. Univita Health will not discriminate in its employment and employment-related decisions against any applicant or employee based on age, race, gender, creed, religion, national origin, disability, marital status, covered veteran status, sexual orientation, status with respect to public assistance, membership or activity on a local commission, or any other characteristic protected under state, federal, or local law.