Claims Adjudication Specialist

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 42,000 - 58,000; Full time

Job summary

CommunityCare HMO Inc. is seeking a Claims Examiner to review and adjudicate claims requiring pre-approval. The role uses CPT codes, medical terminology knowledge and processing software to determine payments, denials or adjustments with accuracy and efficiency.

The candidate should have at least a high school diploma and 2 years of related claims experience or medical billing education, with strong attention to detail and proficient Microsoft Office skills. Equal opportunity employer.

Qualifications

• Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.
• Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures.

Responsibilities

• Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions.
• Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed.
• Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials.
• Identify and communicate trends or problems identified during adjudication process.
• Contribute to the creation of a pleasant working environment with peers and other departments.
• Assist in investigating and solving claims that require additional research.
• Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations.
• Perform other job-related duties as assigned.

Skills

Claims processing

Attention to detail

Reading medical terminology

CPT codes knowledge

Microsoft Office

Communication skills

Education

High School Diploma

2 years related experience

Medical billing education

Tools

Claims processing software

Job description

CommunityCare HMO Inc. is seeking a Claims Examiner to review and adjudicate claims requiring pre-approval. The role uses CPT codes, medical terminology knowledge and processing software to determine payments, denials or adjustments with accuracy and efficiency.

The candidate should have at least a high school diploma and 2 years of related claims experience or medical billing education, with strong attention to detail and proficient Microsoft Office skills. Equal opportunity employer.