Remote Claims Examiner I - Data Entry & Adjudication

American Specialty Health; United States; Remote; USD 40,000 - 60,000; Full time

Job summary

American Specialty Health Incorporated (ASH) is seeking an Examiner I to join our Claims department. The primary purpose is to verify claim information lifted from CMS 1500 by OCR and enter data into the Claims Processing System, then adjudicate claims with accuracy and compliance.

The role requires 6 months data entry experience, familiarity with medical billing terminology, and proficiency in MS Office, with the ability to work from a remote home-based setup and meet production goals.

Qualifications

• High School Diploma or GED certificate required.
• 6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.
• Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
• Proficient in MS Office.
• Ability to work and maintain production in a work-from-home (WFH) environment.
• Demonstrated ability to show self-discipline to meet production goals.

Responsibilities

• Processes claims accurately and efficiently.
• Reviews all incoming claims to verify necessary information.
• Determines that correct member and provider records are chosen and utilized to process claims.
• Enters claims data and information into the computerized Claims Processing System.
• Maintains all required documentation of claims processed and claims on hand.
• Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
• Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.
• Verifies data of scanned paper claims at stated standards.
• Provides backup for other examiners within the department.
• Promotes a spirit of cooperation and understanding among all personnel.
• Attends organizational meetings as required.
• Adheres to organizational policies and procedures.
• Maintains confidentiality of all claim files, claims reports, and claims related issues.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Data entry

Medical claims processing

MS Office

Attention to detail

WFH capability

Education

High School Diploma or GED

Tools

10-key data entry

CMS 1500 familiarity

Job description

American Specialty Health Incorporated (ASH) is seeking an Examiner I to join our Claims department. The primary purpose is to verify claim information lifted from CMS 1500 by OCR and enter data into the Claims Processing System, then adjudicate claims with accuracy and compliance.

The role requires 6 months data entry experience, familiarity with medical billing terminology, and proficiency in MS Office, with the ability to work from a remote home-based setup and meet production goals.