Claims Processor II - ICD 9/10 CPT Required - Remote US

VetJobs; United States; Sur place; USD 38 000 - 57 000; Plein temps

Résumé du poste

Magellan Federal in the United States is seeking a Claims Processor II to support healthcare claims processing. The role emphasizes accurate adjudication, timely payments, and alignment with policy agreements.

Ideal candidates have experience with ICD-9/10 codes and CPT, and possess strong basic analytic and communication skills. Responsibilities include pricing claims with standard tools, maintaining reference materials, and collaborating with the Quality team for procedures.

Qualifications

• Demonstrated ability to navigate computer applications.
• Experience with ICD-9/10 codes and CPT.
• Strong written and verbal communication skills.
• Basic analytical and problem-solving abilities.

Responsabilités

• Process medical/healthcare claims accurately and timely.
• Adjudicate claims and adjustments as required.
• Resolve edits and suspended claims.
• Maintain and update reference materials for adjudication.
• Collaborate with Quality team and leadership coaching.

Connaissances

Navigate computer apps

Analytical skills

Communication skills

Reading comprehension

Formation

High School/GED

Description du poste

Job Description

Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers.

ATTENTION MILITARY AFFILIATED JOB SEEKERS

Must Have

• Medical/healthcare claims processing experience
• Experience with list of ICD 9/10 codes and CPT
• Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.
• Adjudicates claims and adjustments as required.
• Resolves claims edits and suspended claims.
• Maintains and updates required reference materials to adjudicate claims.
• Provides backup support to other team/group members in the performance of job duties as assigned.
• Manually prices claims with various tools and processes to pay the claims.
• Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.
• Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Auto req ID

485959BR

Minimum Education Required

High School/GED

Additional Qualifications/Responsibilities

• Demonstrated ability to navigate computer applications.
• Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
• Demonstrated basic analytical skills.
• Basic written/oral communication skills.
• Demonstrated reading comprehension and ability to follow provided directions.

General Job Information

Title

Claims Processor II

Grade

19

Work Experience - Required

Claims

City*

United States

State*

N/A

Job_Category

Health/Medical other

Job Code

Health-Services health-services

Affiliate Sponsor

Magellan Federal - AFSC

Salary Range

• Salary Minimum $37,725
• Salary Maximum $56,595