Claims Examiner II

HealthEdge is looking for Claims Examiner II, reporting to the Claims Team Leader. The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Claims Examiner II is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).

As a Claims Examiner II at UST HealthProof, this is your opportunity to

Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader
Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management
Mentor junior members of the team
Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader
Knowledge base around physician practices and hospital coding, billing and medical terminology, CPT, HCPCS, and ICD-10, UB04, CMS 1500, authorizations, medical terminology, and concepts of healthcare
Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities

You bring:

High School degree required
1 – 3 years healthcare claims processing experience
Solid understanding and ability to analyse claim data
ICD-10 CPT and HCPCS coding, is a plus
Willingness to learn new skills
Team collaborator
Strong work ethic

For this role, we value:

The ability to adapt quickly to a fast-paced environment
A self-starter and quick learner
Team player with an ability to collaborate