Medical Claims Examiner in Tampa, FL at SNI Companies

Job Description

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 and our Client's internal criteria

• Review different lines of business to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines

• Authorize claim payments within established limits; otherwise forward to Claims Manager

• Potentially process refunds appeals, disputes and adjustments (when applicable);

• Identify process improvement opportunities within the claim department and recommend system enhancements

• Handles any additional responsibility which may be assigned

 

Education :

• High School Diploma or equivalent required

Experience :

• Minimum of one-year experience working closely with health claims or in a claims processing/adjudication environment; required

. Abundance of opportunities for promotion within for those looking for upward mobility

.Meeting and exceeding metrics is rewarded

Technical Skills / Knowledge:

• Understanding of health claims processing/adjudication

• Ability to perform basic to intermediate mathematical computation routines

• Medical terminology strongly preferred

• Understanding of ICD-9 & ICD-10

• Basic MS office computer skills

• Ability to work independently or within a team

• Time management skills

Will go remote after 6 months of employment.