Senior Examiner, Claims (Remote)-Must reside in Florida

Molina Healthcare; Florida; Presencial; USD 21 000 - 40 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive benefits

Resumo da oferta

Molina Healthcare is seeking a senior claims examiner to provide high-level support for claims evaluation, adjudication, and investigation. You will manage diverse caseloads, procure supporting medical records, and recommend resolutions to prevent processing errors.

The role requires at least 2 years in claims, strong data-entry and analytical abilities, and proficiency with Microsoft Office. Competitive benefits are offered. This is an on-site position in Florida.

Qualificações

• At least 2 years of experience in claims, preferably in managed care.
• Strong research and data entry abilities.
• Excellent organizational and time-management skills.
• Effective verbal and written communication.
• Proficiency with Microsoft Office and relevant software.

Responsabilidades

• Evaluates adjudication of claims using standard principles and state regulations.
• Manages a caseload of claims and procures medical records to support claims.
• Makes recommendations for further investigation or resolution of claims.
• Identifies errors in pre-payment adjudication and suggests solutions.
• Monitors medical treatment and keeps detailed records for each claim.
• Ensures compliance with federal and state turnaround times and payments.
• Meets department quality and production standards.
• Supports claims department efficiency initiatives.
• Completes assigned claims projects.

Conhecimentos

Research & data entry

Organizational skills

Time management

Verbal and written communication

Attention to detail

Ferramentas

Microsoft Office

Descrição da oferta de emprego

JOB DESCRIPTION Job Summary

Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors.

• Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
• Manages a caseload of claims - procures all medical records and statements that support the claim.
• Makes recommendations for further investigation and/or resolution of claims.
• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues.
• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.
• Monitors the medical treatment of claimants; keeps meticulous notes and records for each claim.
• Manages a caseload of various types of complex claims - procures all medical records and statements that support the claim.
• Meets state and federal regulatory compliance regulations on turnaround times and claims payment for multiple lines of business (LOBs).
• Meets department quality and production standards.
• Supports all claims department initiatives to improve overall efficiency.
• Completes claims projects as assigned.

JOB DESCRIPTION Job Summary

Provides senior level support for claims examination activities including evaluation of adjudication of claims to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors.

Essential Job Duties

• Evaluates the adjudication of claims using standard principles, and state-specific regulations to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and claims processing errors.
• Manages a caseload of claims - procures all medical records and statements that support the claim.
• Makes recommendations for further investigation and/or resolution of claims.
• Oversees the reduction of defects by identifying error issues as they relate to pre-payment of claims through adjudication, and recommends solutions to resolve issues.
• Identifies and recommends solutions for error issues as it relates to pre-payment of claims.
• Monitors the medical treatment of claimants; keeps meticulous notes and records for each claim.
• Manages a caseload of various types of complex claims - procures all medical records and statements that support the claim.
• Meets state and federal regulatory compliance regulations on turnaround times and claims payment for multiple lines of business (LOBs).
• Meets department quality and production standards.
• Supports all claims department initiatives to improve overall efficiency.
• Completes claims projects as assigned.

Required Qualifications

• At least 2 years of experience in claims, preferably in a managed care setting, or equivalent combination of relevant education and experience.
• Research and data entry skills.
• Organizational skills and attention to detail.
• Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Effective verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

• Health care claims/billing experience.
• Medicaid Experience

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $15 - $29.06 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.