What are the responsibilities and job description for the Claims Examiner position at Independent Living Systems?
About the Role:
The Claims Examiner plays a crucial role in the Health Care Services industry by ensuring that all claims submitted for reimbursement are processed accurately and efficiently. This position involves reviewing medical claims to determine their validity and compliance with established policies and regulations. The ultimate goal is to minimize errors and prevent fraudulent claims while ensuring that healthcare providers are compensated for their services in a timely manner. The Claims Examiner will also be responsible for communicating with healthcare providers and patients to resolve any discrepancies or issues that may arise during the claims process. By maintaining high standards of accuracy and integrity, the Claims Examiner contributes significantly to the overall financial health of the organization and the satisfaction of its clients.
Minimum Qualifications:
- High school diploma or equivalent.
- Experience in claims processing or a related field.
- Strong attention to detail and analytical skills.
Preferred Qualifications:
- Associate's or Bachelor's degree in healthcare administration or a related field.
- Certification as a Claims Examiner or similar credential.
- Experience with medical coding and billing.
Responsibilities:
- Review and analyze medical claims for accuracy and completeness.
- Determine the eligibility of claims based on policy guidelines and regulations.
- Communicate with healthcare providers and patients to clarify information and resolve issues.
- Document findings and decisions in the claims management system.
- Stay updated on industry regulations and changes to ensure compliance.
Skills:
The required skills of attention to detail and analytical thinking are essential for accurately reviewing claims and identifying discrepancies. Strong communication skills are necessary for effectively interacting with healthcare providers and patients to resolve issues. Familiarity with medical coding and billing practices enhances the ability to assess claims accurately. Preferred skills, such as knowledge of industry regulations, are utilized to ensure compliance and mitigate risks associated with claims processing. Overall, these skills contribute to the efficiency and effectiveness of the claims examination process, ultimately supporting the financial stability of the organization.
