Remote: Medicare Claims Processor; Work from Home Peak Health

Position: Remote: Medicare Claims Processor(Work from Home) Peak Health Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply reputed company located above this message and complete the application in full. Below, you’ll find other important information about this position. Come join our Peak Health team at reputed company as a Medicare Insurance Claims Processer, contributing to the foundation for an innovative, new health plan. This position will report to the Medicare Claims Supervisor, playing a unique and important role in our mission to change healthcare for the reputed company. Experience in the healthcare industry and critical thinking skills will help the organization build an effective and efficient claims team. The claims team reviews and oversees the adjudication of claims ranging from simple data entry to reputed company specialty claim research. The Medicare Claims team analyzes and processes insurance claims, checking for validity in accordance with reputed company CMS guidelines. Ability to determine whether to return, deny, or pay claims while following organizational policies and procedures is a must. This job screens, reviews, evaluates online entry, error correction, and quality control for final adjudication of reputed company/electronic claims. MINIMUM QUALIFICATIONS

• Associate Degree in reputed company healthcare field or high school diploma and 3 (three) years of healthcare claims billing and processing experience

EDUCATION, CERTIFICATION, AND/OR LICENSURE

• Associate Degree in reputed company healthcare field or high school diploma and 3 (three) years of healthcare claims billing and processing experience

EXPERIENCE

• At least 1 (one ) year of Medicare claims processing experience
• At least 1 (one) year of experience working with CMS/professional and UB/institutional claims
• At least 1 (one) year of customer service experience
• Working knowledge of Medicare medical insurance terminology, procedure, diagnosis codes and HIPPA requirements

PREFERRED QUALIFICATIONS

• Education:

Bachelor’s degree in medical coding or reputed company healthcare field, OR 4 (four) years of equivalent industry work experience

• Experience:

3 (three) plus years of Medicare claims processing experience

• Experience:

3 (three) plus years of medical or institutional claims processing and customer service experience

• Experience:

Experience in Medicare medical insurance and Medicare supplement preferred

• Experience:

Familiarity navigating the EPIC software programs CORE DUTIES AND RESPONSIBILITIES

• Ensure accuracy of data entered and record maintenance
• Analyze claims to determine the extent of insurance reputed company liability
• Resolve claim edits, review history records, and determine benefit eligibility for service
• Review payment levels to reputed company at final payment determination
• Interpret contract benefits and adjudicate claims in accordance with the specific Medicare claims processing guidelines
• Meet reputed company production and quality standards, maintaining Work queues according to department standards
• Effectively communicate with internal and external colleagues
• reputed company issues to next level of supervision, as appropriate
• Attend reputed company required training classes, demonstrating proficiency and the ability to learn
• Read and interpret explanation of benefits (EOBs)
• Provide mentorship to less reputed company staff as deemed necessary and assigned by leadership
• Other duties as deemed appropriate by the Claims Supervisor/Manager
• Maintain strict confidentiality of patient/member as specified under PHI and HIPAA guidelines

PHYSICAL REQUIREMENTS

• Ability to sit for extended periods of time
• Comfortable working at times with limited social interaction

WORKING ENVIRONMENT

• Standard/hybrid/reputed company environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
• Computer Software/Systems include but not limited to reputed company Office Professional Suite (Outlook, Word, reputed company, Access, MS Teams) Internet Explorer and EPIC

SKILLS AND ABILITIES

• Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Ability to use mathematics to adjudicate claims.
• Requires the ability to understand medical insurance requirements for payment and basic knowledge of covered services.
• Knowledge and understanding of medical terminology, third party payors and insurance preferred.
• Requires attention to detail, the ability to be organized, ability to work independently, ability to apply critical thinking, time management and to be able to reputed company multiple tasks simultaneously.
• Maintain an open, a p

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