Medicare claims examiner

medicare claims examiner.

columbia , tennessee

posted today

job detailssummary

$17 - $18 per hour

temp to perm

high school

category office and administrative support occupations

referenceAB4651279

job detailsLarge health insurance provider, in Columbia, TN, is seeking to add a team member in their Medicare Claims department. If you have a solid understanding of medical claims processing, medical terminology, plan benefits and standard billing practices, then this may be the position for you. Read on to learn more about the position. If interested, today and upload your current, professional resume.salary: $17 - $18 per hourshift: Firstwork hours: 8 AM - 4:30 PMeducation: High SchoolResponsibilitiesThe MCE I is responsible for analyzing, investigating, and adjudicating both basic and complex medical claims to assess their appropriateness of care and completeness of information, in line with accepted coverage guidelines. Claims may be received in either paper or electronic format for review. This role demands a solid understanding of medical claims processing, medical terminology, plan benefits, and standard billing practices, while ensuring compliance with all applicable regulations and best business practices. Key responsibilities include: Successfully complete the claims processing training course with a score of 80% or higher on written exams and maintain no more than 2 accuracy errors per week during live production for final assessment. Conduct thorough analyses while processing claims across multiple plans, accounting for both automated and manual differences in benefits, and utilizing the knowledge base and written documentation to determine the correct payment for specific benefits. Identify and refer all claims with potential third-party liability, such as coordination of benefits (COB). Organize and prioritize workload to ensure timely turnaround. Communicate effectively with leadership regarding any issues that may hinder the accurate and timely adjudication of claims. Collaborate effectively with colleagues and maintain working relationships.The essential functions of this role include:

working in a smoke free environment

Skills

Claims

Medicare Compliance

Claims Processing

Detail Oriented

Time Management

Organizational Skills

Medical Terminology

Understanding of plan benefits

Analytical Thinking

Investigations

Qualifications

Years of experience: 2 years

Experience level: Experienced

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+1 931 381 9675 (tel:+1 931 381 9675)

bunny.gordon@randstadusa.com