Claims Recalculation Specialist

CommunityCare, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 40,000 - 55,000; Full time

Job summary

CommunityCare, Inc. in Tulsa, OK is seeking a Recalculation Examiner to research and reprocess previously adjudicated claims across all lines of business. You will determine actions to pay, deny or adjust, using your knowledge and decision-making acumen to support accurate outcomes.

Examiners are expected to meet performance expectations in accuracy and efficiency, collaborating with multiple departments to resolve issues and improve processes.

Qualifications

• High school diploma or equivalent required.
• Three years related work experience in claims processing, data entry or medical billing.
• One year of claims processing experience within CommunityCare or another healthcare environment is required.

Responsibilities

• Researches and reprocesses claims, coordinating with internal departments.
• Verifies corrected claims and redirects to finalize processing.
• Performs clerical duties related to inquiries and first level appeal letters.
• Responds to first level inquiry appeals received via paper mail.
• Determines amounts of overpayments and processes refunds paperwork.
• Maintains inventory tracking log and follows up on routed claims.
• Interacts with departments to resolve claim corrections and system issues.
• Identifies trends or problems during adjudication and communicates them.
• Resolves unique problems with minimal supervision.
• Contributes to a positive work environment and teamwork.
• Keeps up-to-date with changes in claims processing, benefits, limits and regulations.

Skills

Claims processing

CPT codes

Medical terminology

Microsoft Office

Analytical math

Communication skills

Time management

Attention to detail

Network authorization

Learning agility

Education

High school diploma

Tools

Microsoft Office

Job description

CommunityCare, Inc. in Tulsa, OK is seeking a Recalculation Examiner to research and reprocess previously adjudicated claims across all lines of business. You will determine actions to pay, deny or adjust, using your knowledge and decision-making acumen to support accurate outcomes.

Examiners are expected to meet performance expectations in accuracy and efficiency, collaborating with multiple departments to resolve issues and improve processes.