Claims Examiner I

MagnaCare; Las Vegas (NV); Vor Ort; USD 40.000 - 54.000; Vollzeit

Zusammenfassung

MagnaCare is seeking a detail-focused claims adjudicator to review and adjudicate non-standard reimbursement requests daily. You will apply healthcare contracts, medical terminology, and policies to ensure accurate outcomes while generating letters and questionnaires to obtain required information.

The role requires strong written and verbal communication, solid analytical skills, and the ability to manage multiple priorities.

Qualifikationen

• Knowledge of healthcare contracts, medical terminology, and claims processing procedures.
• Experience with claims adjudication or medical billing is required.
• Ability to research and resolve complex claim issues with strong written and verbal communication.
• Proficiency in Office Suite to generate letters, questionnaires, and reports.

Aufgaben

• Review and adjudicate reimbursement claims that fall outside auto adjudication standards daily.
• Apply medical policies, contractual provisions, and procedures to ensure precise adjudication.
• Generate correspondence and gather information from customers and providers; initiate phone inquiries as needed.
• Collaborate with Customer Service to resolve inquiries and concerns.
• Research and resolve client inquiries and escalations in a timely manner with internal teams.

Kenntnisse

Claims processing

Medical terminology

Healthcare contracts

Analytical thinking

Written communication

Verbal communication

Multitasking

Problem solving

Quality focus

Timeliness

Attention to detail

Tools

Microsoft Word

Microsoft Excel

Jobbeschreibung

Primary Responsibilities

• Review andadjudicateclaimssubmittedfor reimbursement that fall outside auto adjudication standardson a daily basis, ensuring compliance with quality, productivity, and timeliness requirements.

• Applying medical policies, contractual provisions, and operational procedures to ensure precise adjudication and adjustments.

• Generate correspondence, such as letters and questionnaires, to gatheradditionalinformation from customers and providers; may alsoinitiatephone inquiries.

• Collaborate with Customer Service to address and resolve customer inquiries and concerns effectively.

• Research and resolve client inquiries and escalationsin a timely manner, collaborating with internal teams as needed to ensure effective resolution.

• Execute client-requested claim adjustments and provide clear, concise written responses to client inquiries within established deadlines.

• Perform in-depth research on account receivables and spreadsheets that require claim adjustments, delivering thorough and clarifying responses to providers and clients.

• Must be adaptable and willing to provide backup support across various departments and roles as needed

Essential Qualifications

• Strong knowledge of healthcare contracts, medical terminology, and claims processing procedures.

• Prior experience processing claims isrequired.

• Minimum 1 year of experience in medical billing, claims adjudication, or a related role.

• Excellent written and verbal communication skills, with the ability to manage inquiries professionally and efficiently.

• Strong analytical skills with the ability to research and resolve complex claim issues.

• Proficiencyin Microsoft Office Suite, particularly Microsoft Word and Excel.

• Ability to meet production and quality standards while managing multiple priorities.

• Strong problem-solving skills and the ability tomaintainprofessionalism under pressure.