What are the responsibilities and job description for the Senior Claims Examiner position at PayerFusion Holdings LLC?
JOB DESCRIPTION
About Us:
We are a service-based company and as a licensed Third-Party Administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.
Responsibilities:
- Experienced claims processor, claims examiner to process hospital claims "UB-04" and physician claims collections "CMS 1500", claims adjudication, coding and claims coverage determination
- Must have extensive knowledge of hospital and physician billing and collections, knowledge of Medicare, Medicaid, Commercial and PPO claims processing a must
- Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance
- Coding ICD 9 (ICD 10 helpful), knowledge of how to process claims, how to read and interpret policies, CPT codes, Hospital coding and UB 04, Correct Coding Initiative principles and must be fully computer literate in use of Microsoft programs (word, excel, outlook and other every day office support software). Must be proficient with the use of telephone in dealing with customers, providers and members
- Medicare Advantage plans, capitation plans, risk assessment process and payments
Requirements:
- Must have experience in medical claims processing and adjudication, self-motivated, responsible, and with a desire for advancement.
- Knowledge of Microsoft Excel a MUST
Benefits
- Excellent health and dental insurance coverage
- Free vision, life and hospital gap insurance
- 12 paid holidays
- Paid Time Off
- 401K with company match up to 4%
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