Remote Claims Analyst II

TEK Systems; Milwaukee (WI); A distancia; USD 22.000 - 31.000; Jornada completa

Descripción de la vacante

TEKsystems is seeking a Claims Analyst II to examine and process paper and electronic claims from a remote, contract-to-hire role based out of Milwaukee, WI. You will determine whether to return, pend, deny or pay claims in line with established policies and procedures.

Ideal candidates have 2–4 years of medical claims processing experience, knowledge of CPT/ICD-9/10, COB and subrogation, and familiarity with ACA/Medicaid health plans. Coding experience is a plus, and QNXT knowledge is welcomed.

Formación

• High school diploma or equivalent preferred.
• 2-4 years medical claims processing experience required.
• Knowledge of CPT and ICD-9/10; medical terminology, COB processing, subrogation.
• Past experience with ACA, Medicaid, or similar health plans preferred.
• Coding experience preferred.

Responsabilidades

• Adjudicate claims by following departmental policies, operating memos, and corporate guidelines.
• Resolve claims and related issues in compliance with policy provisions.
• Process payments for claims that are approved.
• Reviews claims to ensure compliance with proper billing standards and completeness of information.
• Investigates and resolves pending claims in accordance with established time frames.
• Monitors computerized system for claims processing errors and make corrections and/or adjustments as needed.
• Reviews home office claims for payment up to $18,000.
• Processes specialty claims (transplant, URN, COB) to determine appropriate pricing according to external contract.

Conocimientos

Claims processing

Medical terminology

COB processing

Subrogation

QNXT

Policy interpretation

Educación

High school diploma

Herramientas

QNXT Claims Workflow

Descripción del empleo

TEKsystems is seeking a Claims Analyst II to examine and process paper and electronic claims from a remote, contract-to-hire role based out of Milwaukee, WI. You will determine whether to return, pend, deny or pay claims in line with established policies and procedures.

Ideal candidates have 2–4 years of medical claims processing experience, knowledge of CPT/ICD-9/10, COB and subrogation, and familiarity with ACA/Medicaid health plans. Coding experience is a plus, and QNXT knowledge is welcomed.