Claims Adjudication Specialist

CommunityCare; Tulsa (OK); On-site; USD 40,000 - 60,000; Full time

Job summary

CommunityCare in Tulsa is seeking a Claims Examiner to review and adjudicate claims prior to payment. The role requires examining pended claims, using knowledge to decide actions and ensuring accuracy.

You will enter data in processing software, identify trends, and collaborate with teams. A high school diploma and 2 years in claims processing are required; proficient in Microsoft applications.

Qualifications

• Two years related work experience in claims processing, claims data entry or medical billing.
• High School Diploma or Equivalent.
• Ability to read and understand CPT codes and medical terminology.
• Proficient in Microsoft applications.
• Strong oral and written communication skills.
• Knowledge of COB and unbundling methods is a plus.
• Successful completion of Health Care Sanctions background check.

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

Attention to detail

CPT codes

Medical terminology

Microsoft applications

Communication skills

Self-motivated

Health Care Sanctions background check

Processing software

Education

High School Diploma or Equivalent

Tools

Processing software

Job description

CommunityCare in Tulsa is seeking a Claims Examiner to review and adjudicate claims prior to payment. The role requires examining pended claims, using knowledge to decide actions and ensuring accuracy.

You will enter data in processing software, identify trends, and collaborate with teams. A high school diploma and 2 years in claims processing are required; proficient in Microsoft applications.