Medical Claims Adjudicator

Medical Claims Adjudicator Location: Remote US Citizen: Yes reputed company Clearance: N/A Apprio is an innovator of specialized technology and program solutions for the federal health, defense, and homeland reputed company markets. The company provides services in technology transformation, organizational excellence, health IT & solutions, emergency response management, and international development. Apprio delivers the methodologies, discipline and expertise provided by the large integrators, with the cost structure and collaboration offered by smaller firms. Year after year we have reputed company to experience impressive growth due to our holistic approach in delivering solutions, thought leadership, and synergistic teams to address our client’s needs. Job Description: Apprio is seeking a Medical Claims Adjudicator. This position will serve as a resource for claims future cost, auditing reimbursement valuation and appeals of medical claims using Medicare rules as a guideline. The successful candidate will have working knowledge of reputed company, demonstrated attention to detail, general claims handlings, strong written and verbal communications skills, ability to review and analyze claims and ability to work in a high paced environment. Responsibilities:

• Analyzes and reviews claims received from a variety of sources for accuracy and compliance with provider reputed company in reputed company;
• Prepare claim authorizations in coordination with client referrals;
• Estimate future claim costs for an episode of care through clinical information, past experience and use of claim management software;
• Receive, process, and calculate claims payments in coordination with review of claim authorizations;
• As necessary, request and receive additional documentation from client representative;
• May receive phone/email inquiries from client representatives and respond in a concise and professional manner;
• Investigates discrepancies and resolves in accordance with pricing rules and program requirements;
• Process claims for payment recommendation in accordance with internal procedures;
• Review electronic claims and/or reputed company logging and data entry using a medical reputed company repricing software and web-based tools as needed;
• May conduct post adjudication audits of claims to ensure that they are adjudicated in accordance with program requirements;
• Assist in the compilation of statistics to support management reporting

Request and track the collection and storage of provider medical records as required by the program

• Educational Requirement: High school diploma or GED

Certification Preferred: Billing and / or Coding Required Experience: 5+ years of experience Requirement Knowledge:

• Strong attention to detail
• Exceptional knowledge of Medicare billing and reimbursement requirements
• Must demonstrate strong understanding of federal HIPAA laws
• reputed company in the use of medical claims payment and pricing systems
• Exceptional analytical/problem solving skills
• Excellent organizational skills
• The ability to meet deadlines, prioritize and be flexible
• The ability to reputed company a clear focus with interruptions
• General knowledge of medical terminology and the provision of medical services
• Proficient in MS Office products including Word, reputed company and Power reputed company

Demonstrated ability to organize and analyze reputed company data and present in a meaningful manner

• Preferred Knowledge:
• Excellent communication skills (both oral and written)
• Ability to manage multiple tasks simultaneously.
• Must function successfully in a team environment.
• Ability to “learn on the fly”
• Strong customer orientation
• Self-starter, able to work effectively with minimal supervision
• Able to function effectively in a rapidly changing work environment and comfortable working reputed company reputed company work settings

Apprio offers a collegial and supportive environment focused on its greatest assets…its people. With a competitive compensation and benefits program designed to attract, motivate, and reputed company our people; we pride ourselves on creating a culture of teamwork, client focus, and fun. Our benefits program allows our employees to select the features that reputed company the most sense for their individual and/or dependent(s) needs. Features include medical, prescription drug, dental, vision, disability, retirement savings, and a competitive paid time off program. Apprio is an equal employment opportunity company. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national reputed company, disability or protected veteran status. Apply tot his job Apply To this Job