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in Irving, TX
Claims Examiner
•30 days ago
Hours | Full-time, Part-time |
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Location | Irving, TX Irving, Texas |
About this job
Claims Examiner
ESSENTIAL DUTIES AND RESPONSIBILITIES: The items listed below detail some of the assigned duties and responsibilities for this position. This is not meant to be an all-inclusive list and management reserves the right to change these duties at any time
ESSENTIAL DUTIES AND RESPONSIBILITIES: The items listed below detail some of the assigned duties and responsibilities for this position. This is not meant to be an all-inclusive list and management reserves the right to change these duties at any time
- Claims processing and adjudication; claims research where applicable.
- Meet and/or exceed qualitative and quantitative production standards.
- Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
- Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
- Utilize systems to track complaints and resolutions.
- Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
- Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.
- High school diploma or GED required; some college courses in related field a plus.
- 5 years claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry
- Knowledge of CPT and ICD-10 coding required.
- Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.
- Other experience in processing all types of medical claims helpful.
- Data entry and 10-key by touch/sight required.
- Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
- Concise written and verbal communication skills required, including the ability to handle conflict.
- Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding
- Review of multiple surgical procedures and establishment of reasonable and customary fees.
- Must possess proven judgment, decision-making skills and the ability to analyze.
- Must learn quickly as well as be able to multi-task.
- Must be motivated and possess a sound work ethic.