Claims Processor

A company is looking for a Claims Process Executive (remote).

Key Responsibilities

Review and process claim submissions, ensuring adherence to coverage guidelines and regulations

Approve, deny, or pend claims based on established criteria and maintain internal customer relations

Identify claims with potential third-party liability and ensure compliance with HIPAA policies

Required Qualifications

High School diploma or GED required

Minimum of two to three years of experience in Medicaid and / or Commercial claims processing

Knowledge of medical terminology and billing guidelines (CPT-4, ICD-9, ICD-10, HCPCS, ASA, UB92)

Experience with FACETS and healthcare claims payer processing is highly preferred

Ability to work independently in a remote environment with a secure internet connection