Claims Processor
5 days ago
Short Description:
- Review and verify the accuracy and completeness of submitted medical claims, including patient information, provider details, services rendered, and billed amounts.
- Assess the coding accuracy of diagnoses, procedures, and services according to industry-standard code sets such as ICD-10, CPT, and HCPCS.
- Determine the eligibility of claims based on contract terms, insurance coverage, and medical necessity criteria. Process claims for payment or denial accordingly.
- valuate supporting documentation, such as medical records and invoices, to validate the services billed and ensure compliance with coding guidelines.
- Investigate and resolve discrepancies or discrepancies in claim submissions, collaborating with internal teams, providers, and insurers as needed.
Minimum Requirements:
- Minimum of 2 years' experience
- Above average english communication skills
NOTE: This role is Dayshift and requires 15 days a year on-site.
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