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

VetJobs; United States; On-site; USD 38,000 - 57,000; Full time

Job summary

VetJobs is seeking a Claims Processor II to handle medical/healthcare claims processing in a fast-paced environment across the United States. The role requires experience with ICD-9/10 codes and CPT, ensuring accurate and timely adjudication of claims in line with policies and contractual agreements.

Responsibilities include calculating payments, maintaining reference materials, and collaborating with the Quality team for process clarity and coaching from leadership.

Qualifications

• Experience with medical/healthcare claims processing and adjudication.
• Proficient with ICD-9/10 codes and CPT.
• Strong attention to detail and accuracy in claims processing.

Responsibilities

• Process claims accurately and timely according to policy and contracts.
• Adjudicate claims and adjustments as required.
• Resolve edits and suspended claims.
• Maintain reference materials for adjudication.
• Provide backup support to team members.
• Price claims manually using various tools and processes.
• Review updated materials and share feedback as needed.
• Collaborate with Quality team for procedures and coaching.

Skills

Medical claims processing

Adjudicates claims

Analytical skills

Communication skills

Reading comprehension

Navigate computer applications

Education

High School/GED

Job description

ATTENTION MILITARY AFFILIATED JOB SEEKERS

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. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

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: 486883BR

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
• Work Experience - Preferred
• Education - Required: GED, High School
• Education - Preferred
• License and Certifications - Required
• License And Certifications - Preferred
• Salary Minimum $37,725
• Salary Maximum $56,595
• City*: United States
• State*: N/A
• Job_Category: Health/Medical other
• Job Code: Health-Services health-services
• Affiliate Sponsor: Magellan Federal - AFSC