Remote Claims Analyst II: Adjudicate Medical Claims

TEKsystems; United States; Remote; USD 22,000 - 31,000; Full time

Job summary

TEKsystems seeks a Claims Analyst II to examine and process paper and electronic claims. You will adjudicate, pend, deny, or pay claims per policies and procedures, handling professional and facility claims with strict confidentiality.

You will maintain quality standards, review for proper billing, obtain required information, and resolve issues within established timeframes. Remote work options apply for this role.

Qualifications

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

Responsibilities

• Process Professional and Facility claims for payment per policies.
• Adjudicate claims by following departmental policies.
• Obtain additional information as needed to complete claims.
• Maintain department quality standards and turnaround times.
• Identify COB, workers' compensation, and subrogation issues.
• Review home office claims for payment up to $18,000.

Skills

Claims processing

CPT/ICD coding

COB processing

Subrogation knowledge

Education

High School Diploma

Tools

QNXT Claims Workflow

Job description

TEKsystems seeks a Claims Analyst II to examine and process paper and electronic claims. You will adjudicate, pend, deny, or pay claims per policies and procedures, handling professional and facility claims with strict confidentiality.

You will maintain quality standards, review for proper billing, obtain required information, and resolve issues within established timeframes. Remote work options apply for this role.