Remote Medicaid/Medicare Claims Examiner II

Wellframe; United States; Remote; USD 23.000 - 26.000; Vollzeit

Zusammenfassung

HealthEdge is seeking a Medicaid and Medicare Claims Examiner II for US-remote work. You will adjudicate healthcare claims, review data against policies, and determine payment eligibility. You’ll meet productivity and accuracy targets while supporting team leaders.

Ideal candidates have 1–3 years claims processing experience, strong data analysis skills, and CPT/HCPCS knowledge; ICD-10 is a plus. The role offers remote work across US time zones and opportunities to mentor teammates.

Qualifikationen

• 1–3 years healthcare claims processing experience.
• Solid understanding and ability to analyse claim data.
• ICD-10 CPT and HCPCS coding is a plus.

Aufgaben

• Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader.
• Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management.
• Mentor junior members of the team.
• Collaborate with other team members on special projects as assigned by the team leaders; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader.
• Knowledge base around physician practices and hospital coding, billing and medical terminology, CPT, HCPCS, and ICD-10, UB04, CMS 1500, authorizations, medical terminology, and concepts of healthcare.
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality.
• Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities.

Kenntnisse

Claims processing

Data analysis

Team collaboration

Adaptability

Ausbildung

High School degree

Tools

Medical coding knowledge

Jobbeschreibung

HealthEdge is seeking a Medicaid and Medicare Claims Examiner II for US-remote work. You will adjudicate healthcare claims, review data against policies, and determine payment eligibility. You’ll meet productivity and accuracy targets while supporting team leaders.

Ideal candidates have 1–3 years claims processing experience, strong data analysis skills, and CPT/HCPCS knowledge; ICD-10 is a plus. The role offers remote work across US time zones and opportunities to mentor teammates.