Medicare Claims Processor
New
J
JobgetherHealthcare Insurance
Based in the United StatesFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- At least 3 years of healthcare claims billing and processing experience; at least 1 year of Medicare claims processing experience; at least 1 year of experience working with CMS requirements; at least 1 year of customer service experience.
- Required Skills
- Customer serviceData entry
Requirements
- Associate degree in a related healthcare field, or a high school diploma/equivalent combined with at least 3 years of healthcare claims billing and processing experience.
- At least 1 year of Medicare claims processing experience.
- At least 1 year of experience working with CMS requirements and professional and UB/institutional claims.
- At least 1 year of customer service experience.
- Working knowledge of administrative and clerical procedures, file management, record maintenance, and common office applications.
- Ability to navigate multiple systems simultaneously and follow established procedures and guidelines.
- Strong written and verbal communication, interpersonal, customer service, and telephone etiquette skills.
- Ability to use mathematics and apply claims-processing calculations accurately.
- Understanding of medical insurance payment requirements and basic knowledge of covered healthcare services.
- Knowledge of medical terminology, third-party payors, insurance processes, Medicare terminology, procedure and diagnosis codes, and HIPAA requirements.
- Strong attention to detail, organization, critical thinking, time management, and multitasking skills.
Responsibilities
- Review, analyze, and process Medicare insurance claims in accordance with CMS guidelines, applicable benefits, contracts, and organizational policies.
- Determine appropriate claim outcomes, including whether claims should be paid, denied, or returned for additional information or correction.
- Verify the accuracy of data entry and maintain complete and accurate claim and member records.
- Analyze claims to determine the extent of insurance carrier liability and establish appropriate payment responsibility.
- Resolve claim edits, review member and claim history, and determine eligibility for specific services.
- Interpret Medicare benefit provisions and apply relevant claims-processing guidelines to individual cases.
- Maintain assigned work queues in accordance with departmental production, quality, and service standards.
- Maintain strict confidentiality of patient and member information in accordance with PHI and HIPAA requirements.
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