Medical Claims Examiner-Claims Processor Position Available In Miami-Dade, Florida
Tallo's Job Summary: PayerFusion in Coral Gables, FL is hiring a Medical Claims Examiner-Claims Processor to process hospital and physician claims, adjudicate claims, code, and determine coverage. Responsibilities include processing claims, interpreting policies, coding, and ensuring cost containment efforts. Requirements include experience in claims processing, knowledge of billing, and proficiency in Microsoft Office. Competitive compensation and benefits are offered.
Job Description
Medical Claims Examiner-Claims Processor PayerFusion Coral Gables, FL 33134
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. PayerFusion is seeking to hire an experienced claims processor, claims examiner to process hospital claims “UB-04” and physician claims collections “
CMS 1500
“, claims adjudication, coding and claims coverage determination.
Responsibilities:
Claims processing and claims examining of all incoming claims based departments’ procedures. Interpret, apply and comprehend policy terms, deductibles, coinsurance, copay and policy max Coding ICD 10, knowledge of how to process claims, how to read and interpret policies, CPT codes, Hospital coding and UB 04, Correct Coding Initiative principles. Responsible for searching the various PPO networks and direct contracts database to determine the appropriate network that a claim should be processed through in order to secure the greatest savings to ensure clients continue to benefit from PayerFusion cost containment efforts. Review and perform quality assessments of work being released to clients to ensure claims processing errors are kept at a minimum. Identify claims that should be audited by the Medical Team when the total charges exceed the pre-established PayerFusion criteria. Follow up on network pending claims to ensure that they are released meeting the deadlines. Handles Provider Statements/invoices by contacting the providers to request a complete Meets deadlines promised to clients for claims processing. Other office duties as assigned by Supervisor.
Requirements:
Must have experience in medical claims processing and adjudication, self-motivated, responsible, and with a desire for advancement. Must have extensive knowledge of hospital and physician billing and collections, knowledge of Medicare, Medicaid, Commercial and PPO claims processing is a must. Must be proficient with the use of telephone in dealing with customers, providers and members. Must be able to interpret, apply and comprehend policy terms, deductibles and coinsurance. Fully computer literate in use of Microsoft Office Programs (Word, Excel, Outlook, Teams software).
Bonus Points:
PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry. PayerFusion provides competitive benefits that include vacation, holiday, sick time as well as health insurance and other corporate benefits such as 401K.
