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Medical Claims Examiner
•2 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Land O' Lakes, Florida |
About this job
Job Description
Job Description
JOB TITLE: Medical Claims Examiner
DEPARTMENT: Finance
REPORTS TO: Director of Accounting
LOCATION: 2061 Collier Pkwy Land O' Lakes, FL 34639
SCHEDULE: M-F 8am-5pm (onsite)
POSITION SUMMARY:
Analyze claims to identify/determine the extent of hospice agency liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize, and make daily use of information. Coordinate daily workflow to coincide with payment cycle. Responsible for participating in management in the overall accounts payable functions in the organization. Reports to the Director of Accounting.
EDUCATION AND QUALIFICATIONS:
ESSENTIAL JOB RESPONSIBILITIES:
SKILLS AND COMPETENCIES
DEPARTMENT: Finance
REPORTS TO: Director of Accounting
LOCATION: 2061 Collier Pkwy Land O' Lakes, FL 34639
SCHEDULE: M-F 8am-5pm (onsite)
POSITION SUMMARY:
Analyze claims to identify/determine the extent of hospice agency liability. Interpret contract benefits in accordance with specific claims processing guidelines. Receive, organize, and make daily use of information. Coordinate daily workflow to coincide with payment cycle. Responsible for participating in management in the overall accounts payable functions in the organization. Reports to the Director of Accounting.
EDUCATION AND QUALIFICATIONS:
- High School diploma or GED equivalent. Associates degree in related field is preferred.
- Minimum of one (1) year related experience required.
- Experience in medical/insurance preferred.
- Team-centered with excellent work ethic and reliability.
- Experience with UB/institutional (CMS-UB04) and HCFA/professional (CMS-1500) claims preferred.
- Familiarity with medical terminology, procedure and diagnosis codes preferred.
- Ability to calculate figures and co-insurance amounts.
ESSENTIAL JOB RESPONSIBILITIES:
- Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services.
- Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations.
- Review different payors to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines.
- Support accounts payable activities for accurate and timely processing.
- Complete coding and record accounts payable entries.
- Process refunds, appeals, disputes, and adjustments (when applicable).
- Participate in accounts payable processes.
- Identify process improvement opportunities and recommend enhancements.
- Handles any additional responsibility as assigned.
SKILLS AND COMPETENCIES
- Proficient with technology; highly skilled in dealing with financial and numeric data.
- Strong attention to detail, data entry skills, and proficient in Microsoft Office, with intermediate skills in Excel.
- Ability to multitask, prioritize, and organize efficiently.
- Must possess strong work ethic and maintain strict confidentiality at all times.
- Possess good communication, interpersonal, and analytical skills.
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