Medical Claims Examiner

  • Location
    Atlanta, Georgia
  • Job type
  • Category
    Medical & Science - Billing / Collections

POSITION: Medical Claims Examiner
LOCATION: Atlanta, Ga
DURATION: 3 months *Possibility of extension*
PAY: 20/hr
Hours: 8 -5 m-f

Position Title
Medical Claims Examiner/Processor

Position Summary
A Medical Claims Examiner/processor is responsible for adjudicating medical claims from providers billing Medicare and Medicaid. Quality Assurance and Productivity Standards and HIPAA rules must be adhered to at all times.
Summary of Role and Responsibilities

• Review pricing methodology for multiple plans
• Ensures compliance with all applicable Federal, State and/or County laws and regulations related to our documented guidelines and processes
• Maintains compliance with all company policies and procedures
• Processes claims by entering patient, payment and provider information timely and accurately from a UB or CMS claim form
• Identify and correct any and all duplicate or corrected claims received
• Adjudicate claims with a high level of productivity (average 150 claims per day) and minimum average accuracy levels (Procedural accuracy of 97.0% and Financial accuracy of 97.0%) in accordance with all departmental standards
• Claims payment
• Analyzing medical insurance claims for possible claim errors
• Complete other tasks, as assigned
• Answer and respond to internal and external emails in a professional and courteous manner
Major Challenge:
Quickly adapting and gaining a sound understanding of the different adjudicating standards between multiple clients.

Education, Experience, and Knowledge / Skills / Abilities
Minimum Education Requirements:
• High School Diploma/GED
Work Experience:
• Six months to one year experience with medical claims examiner/processor knowledge

Knowledge, Skills, and Abilities
• Familiar with CPT, HCPCS, ICD-9 and ICD – 10 code sets
• Medicare and Medicaid experience
• Medical claims experience
• Knowledge of medical billing practices
• Computer proficiency (MS Office Suite and Outlook)
• Understanding and ensures compliance of HIPAA laws and regulations
• Able to differentiate between primary and secondary insurance payers
• Excellent interpersonal skills
• Excellent verbal and written communication skills
• Must be well organized and detail-oriented
• Must be able to work extended hours when necessary
• Able to work in a team environment
• Type minimum 60 wpm
• Strong 10 key skills by touch
• Able to adapt and apply additional training initiatives
• Able to differentiate between international and domestic coding guidelines
• Ability to read or have worked with Explanation of Benefits and payments
• Claims Adjustments experience
Preferred Education, Knowledge, Skills and Abilities:
• Previous Claims Examiner experience

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Reference number US_EN_2_022862_399338