Remote Claims Examiner: HIPAA Adjudication & Appeals

Wellcove; Pensacola (FL); On-site; USD 40,000 - 65,000; Full time

Job summary

Wellcove-Pensacola, located at 4900 BAYOU BLVD, PENSACOLA, Florida, United States of America, seeks a claims adjudication specialist to manage outbound calls and adjudicate HP/AD claims. You will work remotely with HIPAA compliance.

Ideal candidate has knowledge of medical terminology, ICD-10, CPT, and the ability to review medical reports, calculate claim amounts, and summarize findings for approved actions.

Qualifications

• Experience handling US HIP claims.
• Knowledge of ICD-10, CPT, surgery procedures, Revenue codes.
• Ability to read and comprehend medical documents.
• Strong English comprehension and attention to detail.

Responsibilities

• Adjudicate HP/AD claims.
• Handle all outbound calls.
• Prioritize work and adjudicate claims as per turnaround time.
• Research, review, summarize, and recommend actions on appeals or grievances.
• Calculate claim amounts for customers.
• Ensure HIPAA compliance and confidentiality.

Skills

Medical terminology

Human anatomy

Basic math

Problem solving

Detail oriented

Willing to learn

Work under pressure

Job description

Wellcove-Pensacola, located at 4900 BAYOU BLVD, PENSACOLA, Florida, United States of America, seeks a claims adjudication specialist to manage outbound calls and adjudicate HP/AD claims. You will work remotely with HIPAA compliance.

Ideal candidate has knowledge of medical terminology, ICD-10, CPT, and the ability to review medical reports, calculate claim amounts, and summarize findings for approved actions.