Healthcare Claims Processor
Karna, LLC
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $22 - $25 per hour
About the role
- Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.
- Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios.
- Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers.
- Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions.
- Uphold the confidentiality of patient records and company information as per HIPAA regulations.
- Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability.
- Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting.
- Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes.
- Mentors and trains new claims processors as needed.
Requirements
- High school diploma or equivalent.
- Minimum of 5 years’ experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims.
- Familiarity with ICD-10, CPT, and HCPCS coding systems.
- Understanding of medical terminology, healthcare services, and insurance procedures (worker’s compensation experience is a plus).
- Strong attention to detail and accuracy.
- Ability to interpret and apply insurance program policies and government regulations effectively.
- Excellent written and verbal communication skills.
- Proficient in Microsoft Office Suite (Word, Excel, Outlook).
- Capacity to work independently as well as collaboratively within a team.
- Commitment to ongoing education and training in industry standards and technology advancements.
- Experience with claim denial resolution and the appeals process.
- Ability to efficiently manage a high volume of claims.
- Customer service-oriented with strong problem-solving capabilities.
- Must be flexible and have the ability to adjust to the needs of the client and changes in the program.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical claims processingICD-10 codingCPT codingHCPCS codingclaim denial resolutionappeals processmedical terminologyhealthcare servicesinsurance proceduresdata analysis
Soft Skills
attention to detailcritical thinkingproblem-solvingcommunicationcollaborationmentoringindependenceflexibilitycustomer serviceorganizational skills