Medicare Claims Examiner II
Core
Adjudicate healthcare claims by reviewing data to determine if services were appropriate and benefit criteria were met, deciding on payment for claims and line items.
Role type
Claims Examiner
Builds
Processed healthcare claims for health insurance clients
Domain
Healthcare insurance claims processing
Required skills
Analyze claim data, Knowledge of physician practices and hospital coding, Medical terminology, CPT coding, HCPCS coding, ICD-10 coding, UB04 forms, CMS 1500 forms, Authorizations
Preferred skills
ICD-10 CPT and HCPCS coding expertise, Process documentation development, Training, Quality audits, Surge activity support
Technologies
Claims processing system, CPT, HCPCS, ICD-10, UB04, CMS 1500
Responsibilities
Process assigned claims based on client guidelines, Meet productivity and accuracy targets, Mentor junior team members, Collaborate on special projects like process documentation and quality audits, Maintain communication with management to ensure processing accuracy
Seniority
Junior to Mid-level, hands-on IC