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    Medical Claims Examiner - Tampa, United States - SNI Companies

    SNI Companies
    SNI Companies Tampa, United States

    1 week ago

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    Description
    Job Description

    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

    Education :


    • High School Diploma or equivalent required

    Experience :


    • Minimum of one-year experience working closely with health claims or in a claims processing/adjudication environment; required
    . Abundance of opportunities for promotion within for those looking for upward mobility

    .Meeting and exceeding metrics is rewarded


    Technical Skills / Knowledge:

    • 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
    Will go remote after 6 months of employment.
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