Medical Claims Reviewer

TEEMA Solutions Group; Chicago (IL); Remote; Full time

Job summary

Join a forward-thinking company as a Medical Claims Reviewer, where your clinical expertise and coding proficiency will play a crucial role in ensuring the accuracy of medical claims. This remote position offers the opportunity to work with a dynamic team, reviewing both inpatient and outpatient claims while collaborating with various stakeholders to resolve inquiries and provide insights. With a focus on detail and analytical skills, you'll contribute to the efficient processing of claims, making a significant impact in the healthcare industry. If you're passionate about making a difference and possess the necessary experience, this role is perfect for you.

Qualifications

• 2+ years of experience reviewing medical claims required.
• Comprehensive understanding of claims workflows is essential.

Responsibilities

• Review medical claims for accuracy and compliance with guidelines.
• Collaborate with teams to resolve claims-related inquiries.

Skills

Medical Coding Practices

Claims Evaluation Processes

Analytical Skills

Effective Communication

Education

High School Diploma or GED

Tools

Claims Review Software

Job description

Job Title: Medical Claims Reviewer
Pay: $26-30/hour - Contract to Hire

Location: Remote

Shift: First(Monday-Friday 8 AM-5 PM)

Position Overview:
We are looking for a skilled and detail-focused Medical Claims Reviewer to perform comprehensive reviews of medical, surgical, and behavioral health claims for inpatient and outpatient services. This role involves using your clinical expertise, coding proficiency, and claims processing knowledge to assess and approve claims accurately and efficiently. You will ensure claims are aligned with program benefits and assist various stakeholders by providing coding-related insights and resolving inquiries related to claims processes.

Primary Responsibilities:

Review and evaluate medical, surgical, and behavioral health claims retrospectively for both inpatient and outpatient care.

Utilize clinical knowledge and coding standards to validate claims and ensure accurate processing.

Gather and prepare the necessary documentation for case payments and approvals.

Verify adherence to program guidelines, benefits, and authorizations.

Collaborate with medical directors, peer reviewers, Claims Administration, and other departments to share relevant clinical and coding information.

Act as a resource for staff on coding and claims-related questions.

Qualifications:

High School Diploma or GED (Required).

At least 2 years of experience reviewing medical claims.

Comprehensive understanding of medical and institutional claims workflows.

Strong grasp of medical coding practices and claims evaluation processes.

High attention to detail with strong analytical and critical-thinking skills.

Effective communication skills and the ability to work across teams.

Proficiency in claims review software and related tools.