Gravie

We partner with brokers across the nation to improve the way people purchase and access healthcare.

Medical Claims Examiner II

Claims SpecialistClaims SpecialistFull TimeRemoteTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

8 days ago

Salary

$43.7K - $72.9K / year

High School4 yrs expEnglish

Job Description

• Support team discussions, aid in team claims issue resolution efficiently, and lead by example. • Accurately review, investigate, and verify coverage to ensure proper processing of medical claims, identifying key processing requirements based on Summary Plan Descriptions (SPD), policies, and departmental procedures • Foster a collaborative team culture through open, honest communication. • Assist with training new team members and support ongoing development through continuous education and skills training. • Support in helping develop team members to perform at their highest level by offering coaching and sharing expertise/best practices. • Review claims queues and provide expertise to address nuances with appropriate parties. • Continually meet department metrics and quality set forth by leadership Provide ongoing feedback to improve departmental workflows and procedures. • Communicate complex claims issues clearly through documentation and direct communications. • Process complex claim scenarios in accordance with Summary Plan Descriptions (SPDs). Areas of expertise include, but are not limited to: Coordination of Benefits (COB), Prior Authorization, Claim Adjustments, Health Reimbursement Arrangements (HRA), Transplant Claims, and High Dollar Claims Processing. • Provide feedback to leadership on system enhancements or training gaps.

Job Requirements

  • High School Diploma
  • 4 + years of experience processing/adjusting and/or analyzing medical claims preferably in a TPA environment
  • Strong knowledge of CPT/HCPC and ICD-10 code rules
  • Ability to set priorities, manage time and work independently
  • Basic proficiency using Windows based other computer applications
  • Functional comfort with Zoom, Microsoft Teams, or Google Meets
  • General knowledge of CMS claims submission regulations
  • Demonstrated success getting results through collaboration
  • Excellent facilitation and transferable knowledge skills communicating effectively on complex concepts
  • Extra credit:
  • Medical Coding experience/certification
  • Medical Billing experience
  • Understanding of provider data
  • Previous start-up company experience
  • Degree in Healthcare Administration or similar field
  • Training and ability to create processes/procedure documentation is a plus
  • Previous experience using Javelina processing system

Benefits

  • Alternative medicine coverage
  • Flexible PTO
  • Up to 16 weeks paid parental leave
  • Paid holidays
  • 401k program
  • Cell phone reimbursement
  • Transportation perks
  • Education reimbursement
  • 1 week of paid paw-ternity leave

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