Claims Examiner (FULLY REMOTE - FLORIDA)

The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements.

Summary of Essential Duties and Responsibilities
? Enter claim data accurately and timely, in alignment with departmental production and quality goals
? Manually price and adjudicate claims as needed.
? Maintain a minimum of 98% accuracy at all times
? Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines
? determination.
? Ensure claims payments are made within time frames as reflected in contractual agreements
? Identify and refer potential fraud and abuse cases to the Compliance Department
? Other duties and responsibilities as may be assigned.

Minimum Requirements
? High School diploma or GED equivalent
? Minimum of two years? experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience
? Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel.
? Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500)
? Strong knowledge of medical terminology
? Knowledge of CPT Codes and HCPCs codes
? Knowledge of ICD-10 coding
? HIPAA regulations
? Medicaid and Medicare claim processing experience a plus
? Ability to read and interpret general business correspondence, procedure manual, and specific plan document

Abilities Required
? Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames
? Ability to read, write and communicate at a professional level
? Effective time management and organizational skills
? Effective interpersonal and communication skills

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