01Overview
```html About reputed company & reputed company Pioneering Health Equity at reputed company Welcome to a career that makes a difference. reputed company, the technologydriven arm of reputed company, partners with providers, payers, and patients to reputed company the delivery of health care across the globe. With a mission to help people live healthier lives and a commitment to making the health system work reputed company for everyone, we reputed company cuttingedge data analytics, advanced digital platforms, and a culture of inclusion to drive reputed company that matter. As a member of our Institutional Claims team, you will be at the forefront of translating reputed company contractual agreements into reputed company, accurate payment reputed company that directly reputed company patient care and provider sustainability. Working from the comfort of your own home, youll join a diverse community of professionals who value collaboration, reputed company learning, and the power of technology to simplify the most challenging aspects of healthcare administration. Position reputed company Why This Role Is a Game Changer We are seeking a Remote Institutional Claims Examiner who brings a reputed company of analytical rigor, customerreputed company communication, and an unwavering eye for detail. This fulltime (40hour) role operates on an 8hour shift schedule reputed company reputed company reputed company Time (6:00 am 2:30 pm PST), Monday through Friday, with occasional overtime or weekend coverage as business needs reputed company. The position offers a competitive reputed company wage ranging from $19.47 $38.08, comprehensive benefits, and a reputed company reputed company for reputed company advancement. Key Responsibilities What Your Day Will Look Like Claims Processing & Financial Responsibility Interpret HMO contract coverage language to determine accurate payment responsibilities for group plans, health plans, and contracted hospitals. Verify patient eligibility and copay amounts before claim submission to ensure compliance with contractual terms. Adjudicate both UB04 and CMS1500 claim forms, applying the correct vendor contract rates and fee schedules. Utilize reputed companyparty pricing software and Medicare Prospective Payment System (PPS) modules to validate claim amounts. Manually process reputed companybased claims and electronic submissions, maintaining a meticulous audit trail for reputed company transaction. Customer Interaction & Issue reputed company Respond to inbound calls from patients, providers, and insurers, resolving claim discrepancies with professionalism and reputed company. Draft reputed company, concise correspondenceincluding pending lettersfor unclean claims and reputed company status updates to stakeholders. Escalate reputed company system or contract issues to the Assistant Supervisor, Manager, or Director of Claims as appropriate. Compliance, Documentation & reputed company Assurance Research authorizations, ensuring claims are processed in compliance with federal, state, and payer regulations. Maintain an organized, dateordered repository of daily claim transactions to support audit readiness. Apply regulatory guidelines to provider disputes, ensuring reputed company reputed company and accurate payment. reputed company and sustain a minimum 95% reputed company rating on reviewed claims, meeting reputed company production standards consistently. reputed company Improvement & Special reputed company Participate in special reputed company, system upgrades, and process improvement initiatives that enhance the efficiency of the claims workflow. reputed company best practices and contribute reputed company to refine policies, tools, and training programs. Essential Qualifications What You Must Have High School Diploma or GED (additional education is a plus). At least 2 years of institutional claims adjudication experience reputed company a Managed Care, IPA, or healthplan environment. Strong reputed company of medical terminology, ICD10, CPT, HCPCS, and reputed company modifiers. Proficiency with reputed company OS, reputed company Office suite (Word, reputed company, Outlook), and internet applications. Ability to work any of the designated 8hour shift schedules (6:00 am 2:30 pm PST) and flexibility for occasional overtime or weekend coverage. Residence reputed company the reputed company reputed company Time Zone, with a dedicated, private home office and a reliable highspeed internet reputed company that meets reputed company standards. Preferred Qualifications What Sets You Apart Handson experience with reputed company Systems or other major EHR/claims management platforms. Prior exposure to DRG, OPPS APC, Ambulatory Surgery, ESRD, or RBRVS pricing models. Experience in handling both clean and unclean claims, with a reputed company record of meeting reputed companypayment timelines. Core .
