What are the responsibilities and job description for the Claims Examiner position at GBIT (Global Bridge InfoTech Inc)?
Role: Claims Examiner- ONSITE
Contract: Long Term
Location: Irving, TX 75039
Summary:
The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as ensuring compliance with federal regulations. This role works in conjunction with Business Configuration, Network Management, Provider Data, Complaints, Appeals and Grievances, as well as other operational departments to ensure validation and quality assurance of claims processing.
Experience:
- Minimum of 3 years’ experience processing medical claims in the healthcare industry
- Prior experience working with managed care, Medicare, Medicare Advantage, Health Exchange, and TRICARE are highly desirable
- Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities, physicians, Home Health, Durable Medical Equipment providers, laboratories, etc.
Responsibilities:
- Review, analyze, and resolve complex medical claims
- Ensure compliance with claims processing guidelines and federal regulations
- Collaborate with various departments to ensure quality assurance of claims processing
- Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from various providers
Required Education Level:
- Associate's degree or equivalent job-related experience required
