Claims Examiner Senior

Innova Solutions is immediately hiring for a < Claims Examiner Senior>

Position type: Full-time, Contract

Duration: 03 Months possibility of extension

Location: Irving TX 75039

As a(n) Claims Examiner Senior you will:

• Required Education Level: Associate's degree or equivalent job-related experience required, Submit with education verification
• Experience Minimum of 3 years experience processing medical claims in the healthcare industry. Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable

• Job Requirements: Associate's degree or equivalent job-related experience required. Experience
• Minimum of 3 years experience processing medical claims in the healthcare industry.
• Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable. Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc.
• The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as ensuring compliance with federal regulations. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing. Responsibilities:
• The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as ensuring compliance with federal regulations. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing. Responsibilities: Meets expectations of the applicable Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures, desktops, processing guidelines, and federal regulations.
• Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc.
• Work claims projects resulting from overpayments or underpayments related to manual processing errors, benefit updates, and/or contract, fee schedule changes. Process provider refunds, reconsiderations, and direct member reimbursements. Process medical claim adjustments, recovery of claim overpayments, and execution of claim batch adjudication. Solve moderately complex claims and escalate issues to the Claims Team Lead, Supervisor or Manager. Assist with database improvements and testing for system upgrades, conversions, or implementation of new processes. Serves as a resource to assist with training new associates, retraining current associates on new/updated desktops/policies and reports staff progress, deficiencies, and training needs to management. Sets high standards of performance and promotes teamwork to achieve established team goals, while maintaining a positive, professional attitude. Contacting/responding to internal and external customers for resolution on claim issues. Assist claims leadership to identify claim trends, gaps in workflow and create/update desktops and policies and procedures. Collaborate with and maintain open communication with all departments within Client to ensure effective and efficient workflow and facilitate completion of tasks/goals. Must be able to organize and prioritize work to meet deadlines. Have good judgment, initiative, and problem-solving abilities. Attention to detail is critical to ensure timely and accurate processing of claims. Consistently meet established productivity and quality standards. Follow Client Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI). Performs other duties assigned by management to support claims functions, which are focused on achieving both departmental and organizational objectives. Must be knowledgeable about medical terminology, CPT, HCPCS, ICD-10, Revenue Codes, CMS-1500 and CMS-1450/UB-04 claim forms and reimbursement methodologies. Must have excellent written, verbal, organizational and interpersonal communication skills. Must be proficient in Microsoft Office, Power Point, Excel, Word, Outlook, spreadsheet, and database skills. Job Requirements: Education/Skills associate s degree or equivalent job-related experience required. Experience Minimum of 3 years experience processing medical claims in the healthcare industry. Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable. Licenses, Registrations, or Certifications None required. Work Schedule: 5 Days - 8 Hours Work Type: Full Time

The ideal candidate will have: Claims Examiner Senior

Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.

We are currently interviewing to fill this and other similar positions. If this role is not a fit for you, we do offer a referral bonus program for referrals that we successfully place with our clients, subject to program guidelines. ASK ME HOW.

Thank you!

Rishabh singh baghel

PAY RANGE AND BENEFITS:

Pay Range*: $24 - $25 per hour

*Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.

Benefits: Innova Solutions offers benefits( based on eligibility) that include the following: Medical & pharmacy coverage, Dental/vision insurance, 401(k), Health saving account (HSA) and Flexible spending account (FSA), Life Insurance, Pet Insurance, Short term and Long term Disability, Accident & Critical illness coverage, Pre-paid legal & ID theft protection, Sick time, and other types of paid leaves (as required by law), Employee Assistance Program (EAP).

ABOUT INNOVA SOLUTIONS: Founded in 1998 and headquartered in Atlanta, Georgia, Innova Solutions employs approximately 50,000 professionals worldwide and reports an annual revenue approaching $3 Billion. Through our global delivery centers across North America, Asia, and Europe, we deliver strategic technology and business transformation solutions to our clients, enabling them to operate as leaders within their fields.

Recent Recognitions:

• One of Largest IT Consulting Staffing firms in the USA Recognized as #4 by Staffing Industry Analysts (SIA 2022)
• ClearlyRated Client Diamond Award Winner (2020)
• One of the Largest Certified MBE Companies in the NMSDC Network (2022)
• Advanced Tier Services partner with AWS and Gold with MS

Website:

Innova Solutions is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Innova Solutions is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at or . Please indicate the specifics of the assistance needed. Innova Solutions encourages all interested and qualified candidates to apply for employment opportunities. Innova Solutions (HireGenics/Volt) does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. 1324b.

The company will consider for employment qualified applicants with arrest and conviction records in a manner that complies with the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative for Hiring Ordinance, and other applicable laws.