Claims Adjudicator 2

Under the direction of the Claims Supervisor, this position is responsible to review claims for payment at the Adjudicator 2 level in accordance with internal guidelines and contractual arrangements. The Claims Adjudicator 2 will interact with other departments, clinic personnel patients and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

• Resolve system suspended claims.
• Initiate contractual adjustments to claims and process for payment.
• Ascertain that a valid authorization exists for each claim prior to payment processing.
• Research claims that do not have all the required information for processing and request claim correspondence.
• Process denials in accordance with contractual arrangements and policy guidelines.
• Process claim reversals and corrections.
• Audit claims for 11unbundled charges11 and correct use of CPT, RVS, ICD-10, HCPCS codes.
• Prepare and refer claims to other departments for review.
• Responsible for identifying billing errors and possible fraudulent claims submissions.
• Manual calculation of benefits when applicable.
• Identify requests for overpayment refunds.
• Process all claims for specialties assigned to Adjudicator 2 (Non-contracted, Complex Claims).
• Assist with processing of claim specialties assigned to Adjudicator Trainee and Adjudicator 1, when required.
• Assist Claim Supervisor in the monitoring of check run process.
• Be flexible and adaptable.
• Promote departmental and organizational goals.
• Know and follow applicable safety standards.
• Take the initiative in offering your help to co-workers in overload situations (when possible).
• Perform other tasks and duties as assigned in a timely manner.
• Perform other duties as assigned.
• Position is eligible for remote option.

• High school diploma/certificate required.
• Minimum 3 years' in medical billing and/or claims processing (at least 2 years in claim processing).
• Knowledge of departmental policies and procedures.
• Strong communication skills.
• Must be able to communicate effectively both written and verbal.
• Knowledge of medical terminology required.
• Ability to organize and prioritize workload and multi-task.
• Working knowledge and proficiency with Microsoft Office applications (Word, Excel, Outlook, etc.)
• Proven ability to work with all matters of a confidential nature.
• Ability to use correct punctuation, grammar and spelling.

The pay range for this position at commencement of employment is expected to be between $22.58 and $26.56. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.