- Consistently meet or exceed all productivity and quality metrics for their role over a 3-month period
- Demonstrate the ability to collaborate effectively and maintain strong communication with team members while working remotely
- Have no active performance improvement plans or disciplinary issues
- Once the above criteria are met, the employee may submit a request to work from home up to 2 days per week. Approval will be at the manager's discretion based on business needs and the employee's proven performance.
- Any decrease in productivity or engagement may result in the flexible arrangement being discontinued.
- Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services
- Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria
- Review different lines of business to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines
- Authorize claim payments within established limits; otherwise forward to Claims Manager
- Potentially process refunds appeals, disputes and adjustments (when applicable)
- Identify process improvement opportunities within the claim department and recommend system enhancements
- Handles any additional responsibility which may be assigned
- Preference for minimum of one-year experience working closely with healthcare claims or in a claims processing/adjudication environment
- Open to training candidates without experience
- Understanding of health claims processing/adjudication
- Ability to perform basic to intermediate mathematical computation routines
- Medical terminology strongly preferred
- Understanding of ICD-9 & ICD-10
- Basic MS office computer skills
- Ability to work independently or within a team
- Time management skills
- Written and verbal communication skills
- Attention to detail
- Must be able to demonstrate sound decision-making skills
- Dental insurance
- Health insurance
- Vision insurance
- Performance Bonus
- Referral Bonus
- PTO
- 8 hour shift
- Monday to Friday
- Flexible schedule
- Phoenix, AZ 85021: Reliably commute or planning to relocate before starting work (Required)
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Healthcare Claims Adjudicator with Possibility of Remote Work - Phoenix, United States - ImageNetLLC
Description
Job Description
Job DescriptionSalary: $15 - $18/per hour DOEImagenet is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. We are looking for Claims Examiners to join our rapidly growing team in Tampa. Experience is preferred but not necessary. Candidates with the right aptitude and desire to learn will be given the required training to be successful. We are excited for this limited opportunity to train candidates that have a phenomenal work ethic and want to learn a new trade. You will receive in-depth training on industry standards, coding, and metrics. Please apply if you exhibit the focus and desire to do great things
We offer great benefits, flexible hours, and the opportunity for remote work for self-disciplined candidates who can perform well under limited supervision. Imagenet offers unlimited opportunities for candidates looking for upward mobility. Our leaders are always promoted from within and there is not a minimum employment time frame if you qualify for promotions. We appreciate referrals and always look to reward employees who help us grow.
$500 HIRING BONUS AFTER 90 DAYS OF SUCCESSFUL EMPLOYMENT
MUST BE LOCAL TO PHOENIX
Do not apply if you are not local to Phoenix
This position is based in our Phoenix office. However, employees who consistently meet performance metrics are eligible for a flexible work arrangement that allows working from home. To qualify, employees must:
We strive to provide flexibility where possible to employees who have demonstrated success in their role. This policy is subject to ongoing review and may be updated or discontinued based on business requirements.
Job Description
Education: High School Diploma or equivalent required
Experience:
Technical Skills / Knowledge:
Salary: $ $18.00 per hour based on experience.
**$500 bonus after 90 days of SUCESSFUL employment
Job Type: Full-time
Benefits:
Schedule:
Work Location: Hybrid remote in Phoenix, AZ 85021
Ability to commute/relocate:
COMPANY OVERVIEW
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans' members and providers.
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans' members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly-owned global delivery center in the Philippines.
Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
