Entry-Level Healthcare Claims Examiner | Adjudication

Florida Blue Group; Irving (TX); Vor Ort; USD 55.000 - 75.000; Vollzeit

Benefits dieser Stelle

Medical, dental, vision insurance

Paid time off (PTO)

11 holidays

Zusammenfassung

WebTPA, a GuideWell Company, is seeking a Claim Examiner to handle processing and adjudication for healthcare claims, including research and complex case work. The role emphasizes accurate determination of medical necessity and coverage under policy guidelines.

Training will prepare you to meet production standards and respond to inquiries from providers. Ideal candidates have healthcare claims experience, familiarity with CPT/ ICD-9 coding, HIPAA and COBRA, plus strong communication and

Qualifikationen

• 2+ years of related work experience.
• Claims examiner/adjudication on a computerized system in the healthcare industry.
• High school diploma or GED.
• Knowledge of CPT and ICD-9 coding.
• Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits.
• Must possess proven judgment, decision-making skills and the ability to analyze.
• Ability to learn quickly and multitask.
• Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
• Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
• Review of multiple surgical procedures and establishment of reasonable and customary fees.

Aufgaben

• Day-to-day processing of claims for accounts (medical, dental, vision, and mental health).</br>• Claims processing and adjudication.
• • Claims research where applicable.
• • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
• • Meet and/or exceed qualitative and quantitative production standards.

Kenntnisse

Claims adjudication

CPT coding knowledge

HIPAA compliance

COBRA knowledge

Communication skills

Multitasking

Microsoft Windows

Microsoft Word & Excel

Decision making

Medical billing experience

Ausbildung

High school diploma or GED

Some college courses

Tools

Medical CPT coding software

Jobbeschreibung

WebTPA, a GuideWell Company, is seeking a Claim Examiner to handle processing and adjudication for healthcare claims, including research and complex case work. The role emphasizes accurate determination of medical necessity and coverage under policy guidelines.

Training will prepare you to meet production standards and respond to inquiries from providers. Ideal candidates have healthcare claims experience, familiarity with CPT/ ICD-9 coding, HIPAA and COBRA, plus strong communication and