Medical Claims Examiner II
Gravie
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $43,725 - $72,875 per year
About the role
- Support team discussions, aid in team claims issue resolution efficiently, and lead by example.
- Accurately review, investigate, and verify coverage to ensure proper processing of medical claims, identifying key processing requirements based on Summary Plan Descriptions (SPD), policies, and departmental procedures
- Foster a collaborative team culture through open, honest communication.
- Assist with training new team members and support ongoing development through continuous education and skills training.
- Support in helping develop team members to perform at their highest level by offering coaching and sharing expertise/best practices.
- Review claims queues and provide expertise to address nuances with appropriate parties.
- Continually meet department metrics and quality set forth by leadership Provide ongoing feedback to improve departmental workflows and procedures.
- Communicate complex claims issues clearly through documentation and direct communications.
- Process complex claim scenarios in accordance with Summary Plan Descriptions (SPDs). Areas of expertise include, but are not limited to: Coordination of Benefits (COB), Prior Authorization, Claim Adjustments, Health Reimbursement Arrangements (HRA), Transplant Claims, and High Dollar Claims Processing.
- Provide feedback to leadership on system enhancements or training gaps.
Requirements
- High School Diploma
- 4 + years of experience processing/adjusting and/or analyzing medical claims preferably in a TPA environment
- Strong knowledge of CPT/HCPC and ICD-10 code rules
- Ability to set priorities, manage time and work independently
- Basic proficiency using Windows based other computer applications
- Functional comfort with Zoom, Microsoft Teams, or Google Meets
- General knowledge of CMS claims submission regulations
- Demonstrated success getting results through collaboration
- Excellent facilitation and transferable knowledge skills communicating effectively on complex concepts
- Extra credit:
- Medical Coding experience/certification
- Medical Billing experience
- Understanding of provider data
- Previous start-up company experience
- Degree in Healthcare Administration or similar field
- Training and ability to create processes/procedure documentation is a plus
- Previous experience using Javelina processing system
Benefits
- Alternative medicine coverage
- Flexible PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- 401k program
- Cell phone reimbursement
- Transportation perks
- Education reimbursement
- 1 week of paid paw-ternity leave
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical claims processingCPT codingHCPC codingICD-10 codingCoordination of Benefits (COB)Prior AuthorizationClaim AdjustmentsHealth Reimbursement Arrangements (HRA)Transplant ClaimsHigh Dollar Claims Processing
Soft Skills
team collaborationcommunicationcoachingfacilitationtime managementindependent workproblem-solvingfeedback provisiontrainingprioritization
Certifications
Medical Coding certificationMedical Billing certification