Claims Examiner

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Intro:

Are you an experienced Claims Examiner looking for a new opportunity with a prestigious healthcare company? Do you have claims adjudication or facility claims experience in healthcare? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:

Conducts claims payment analyses to identify root cause of claims issues/deficiencies.

Adjudicates medical claims

Verifies patient account, eligibility, benefits and authorizations.

Prioritizes assigned claims according to regulatory timelines.

Requests additional information for incomplete or unclean claims; follows up with provider as necessary.

Runs claims report to adjudicate adjustments due to retroactive effective date of contract or fee schedule changes.

Corresponds with IPAs/Medical Groups regarding misdirected claims.

Requirements:

2-5 years medical claims examining experience,

Minimum typing speed of 45 WPM and use of Ten-Key by touch

Knowledge of ICD9-CM, HCPCS level II and III, CPT, and revenue Codes, DRG and APC coding a plus

Knowledge of different payment methodologies such as Medi-Cal, RBRVS, DRG and other Medicare reimbursements

If you are interested, PLEASE CONTACT Tyler AT 407-478-0332 EXT 117