Senior Healthcare Claims Processor — Remote Adjudication Expert

General Dynamics Information Technology, Inc.; Oregon; Hybrid; USD 24.000 - 30.000; Vollzeit

Benefits dieser Stelle

Remote work options

Competitive benefits package

Zusammenfassung

General Dynamics Information Technology, Inc. seeks a Healthcare Senior Claims Processor to support day-to-day medical claims operations within a Third-Party Administrator environment serving the World Trade Center Health Program.

The role requires 5+ years of experience, strong CPT/ICD-10 knowledge, and the ability to adjudicate complex, high-dollar claims while mentoring staff and contributing to process improvements. Remote work is available where appropriate.

Qualifikationen

• Minimum 5 years of hands-on experience processing medical professional and facility claims.
• Strong working knowledge of ICD-10, CPT, HCPCS, revenue codes, and modifiers.
• Experience resolving claim denials, appeals, and complex adjudication questions.
• Ability to interpret and apply payer policies and federal regulations.

Aufgaben

• Evaluate, process, and adjudicate professional, facility, complex, and high-dollar claims in alignment with program policies and federal guidelines.
• Interpret and apply reimbursement requirements, billing rules, modifiers, benefit limitations, and regulatory guidance.
• Resolve escalated claim issues, variances, exceptions, and discrepancies.
• Provide day-to-day technical expertise to claims processors on complex adjudication scenarios.
• Ensure accuracy, timeliness, and compliance with service-level requirements.
• Help define and maintain claims workflows, operating procedures, escalation paths, and quality controls.
• Translate claims policies and system rules into clear, repeatable processing instructions.
• Recommend operational improvements to increase efficiency, accuracy, and consistency.
• Assist with updates to standard operating procedures when requirements change.
• Support training programs for new and existing claims processors.
• Develop or refine job aids, desk guides, examples, and knowledge-check materials.
• Provide coaching on claims quality, system navigation, and procedural accuracy.
• Identify knowledge gaps and recommend targeted training interventions.
• Participate in claims quality reviews, calibration sessions, and root-cause analysis.
• Document claim decisions clearly and support internal and external audit requests.
• Monitor emerging trends and propose changes to training, processes, or system rules.
• Promote adherence to privacy, data security, federal requirements, and organizational policies.

Kenntnisse

CPT Coding

Healthcare Claims

ICD-10 Procedure Coding System

Jobbeschreibung

General Dynamics Information Technology, Inc. seeks a Healthcare Senior Claims Processor to support day-to-day medical claims operations within a Third-Party Administrator environment serving the World Trade Center Health Program.

The role requires 5+ years of experience, strong CPT/ICD-10 knowledge, and the ability to adjudicate complex, high-dollar claims while mentoring staff and contributing to process improvements. Remote work is available where appropriate.