What are the responsibilities and job description for the Claims Examiner Sr position at TalentBurst, an Inc 5000 company?
Title: Claims Examiner Sr
Location: Irving, TX 75038
Duration: 3 Months
Job Requirements:
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.
Summary: 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 client's 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
Education/Skills
• Associate's degree or equivalent job-related experience required.
#TB_HC
Location: Irving, TX 75038
Duration: 3 Months
Job Requirements:
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.
Summary: 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 client's 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
Education/Skills
• Associate's degree or equivalent job-related experience required.
#TB_HC
Salary : $21 - $24
