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Claims Examiner

Miramar, FL 33025

Posted: 01/24/2021 Employment Type: Temp Category: Healthcare Job Number: 254824 Pay Rate: 17.00

Job Description

  • Must be able to verify that claims are paid in accordance with correct contractual provision regulatory guidelines
  • Knowledge of general processing for both health care providers and institutions
  • Generate and utilize reports to perform “pre” and “post” audit for all examiners, at all level and to capture deficiencies in processed claims prior to check run.
  • Must be able to work independently and successfully with limited supervision
  • Must be able to work with Claims Examiners, give direction and answer claims related questions to improve overall quality of the department and individual examiners.
  • Investigate, evaluate and resolve claims through the normal claim handling process. Achieve optimal results through proper litigation and vendor management. Review, analyze and provide opinions as to claim handling practices of claims handled by Third Parties.
  • Representative claim audits typically include Professional Liability, General Liability, Excess, Auto, or Workers’ Compensation claims.
  • Depending on experience and ability, the position may require project management responsibilities where the individual will direct and oversee audits and manage assigned auditors

Job Requirements

Must be able to work full-time days
Must have 3 + years experience investigating, evaluate and processing claims experience processing Medicare and Medicaid claims
•Must be proficient in Microsoft environment, with intermediary level in Excel, Word, and SharePoint
•Detail Oriented
•Exceptional Customer Service and organizational skills
•Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required
•Extensive knowledge of medical terminology with thorough comprehension in the usage of HCPCS, Revenue, and ICD-9 codes.

Meet Your Recruiter

Melissa Matos

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