Claims Examiner (FULLY REMOTE - FLORIDA)

The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements. Summary of Essential Duties and Responsibilities • Enter claim data accurately and timely, in alignment with departmental production and quality goals • Manually price and adjudicate claims as needed. • Maintain a minimum of 98% accuracy at all times • Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines • determination. • Ensure claims payments are made within time frames as reflected in contractual agreements • Identify and refer potential fraud and abuse cases to the Compliance Department • Other duties and responsibilities as may be assigned. Minimum Requirements • High School diploma or GED equivalent • Minimum of two years’ experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience • Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel. • Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500) • Strong knowledge of medical terminology • Knowledge of CPT Codes and HCPCs codes • Knowledge of ICD-10 coding • HIPAA regulations • Medicaid and Medicare claim processing experience a plus • Ability to read and interpret general business correspondence, procedure manual, and specific plan document Abilities Required • Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames • Ability to read, write and communicate at a professional level • Effective time management and organizational skills • Effective interpersonal and communication skills Apply Job!