Medical Claims Examiner Job Opportunity

Position Description

Research, resolve, examine and process paper and/or electronic claims submitted for payment. Interact with internal customers to obtain needed information for claim processing. Process claims reviewing Policies and Procedures, Coordination of Benefits, and applying appropriate plan provisions, CMS Regulations and DHS guidelines for payment determination.

• Ensure accurate and timely processing of claims in accordance with DHS and CMS Regulations and Claims Department Work Instructions.

• Maintain department production and quality standards.

• Work pending file as directed by Claims Leadership. Follow up on pending claims according to Department Service Level Agreements.

• Interaction with internal customers to obtain needed information to process claims and to provide detailed claim information.

• Other duties as assigned.

Education

High School diploma or equivalent required.

Required Experience

Six months experience with medical claims knowledge. Knowledge of ICD10 and CPT coding and medical terminology experience. Previous claims processing.

Preferred Experience

Experience in a healthcare organization, working knowledge of Medicaid, Medical Assistance, Minnesota Care, Medicare and Commercial is helpful. Amisys Claims System and MACESS EXP experience a plus.