Broadway Ventures - Remote Medical Claims Processor I (Temporary role)

Remote - ET (Eastern)1w ago

Remote Junior NA Insurance Healthcare Remote Assistant Microsoft Office Excel Team Management Mentoring Reporting

Requirements

• High school diploma or equivalent. • Billing experience doesn't count towards years of experience qualification • Familiarity with ICD-10, CPT, and HCPCS coding systems. • Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker’s compensation claims is a plus). • Strong attention to detail and accuracy. • Ability to interpret and apply insurance program policies and government regulations effectively. • Excellent written and verbal communication skills. • Proficiency in Microsoft Office Suite (Word, Excel, Outlook). • Ability to work independently and collaboratively within a team environment. • Commitment to ongoing education and staying current with industry standards and technology advancements. • Experience with claim denial resolution and the appeals process. • Ability to manage a high volume of claims efficiently. • Strong problem-solving capabilities and a customer service-oriented mindset. • Flexibility to adjust to the evolving needs of the client and program changes.

Responsibilities

• Claims Review and Processing • Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. • Critical Analysis • Critical Analysis • Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. • Timely Processing • Timely Processing • Ensure prompt claims processing to meet client standards and regulatory requirements. • Identify and resolve any barriers using effective problem-solving strategies. • Issue Resolution • Issue Resolution • Collaborate with internal departments to proactively resolve discrepancies and issues. • Use analytical skills to identify root causes and implement solutions. • Confidentiality Maintenance • Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. • Detailed Record Keeping • Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. • Trend Monitoring • Trend Monitoring • Analyze and report trends in claim issues or irregularities to management. • Assist Team Leads with reporting to contribute to continuous process improvements. • Audit Participation • Audit Participation • Engage in audits and compliance reviews to ensure adherence to internal and external regulations. • Critically evaluate and recommend process improvements when necessary. • Mentoring • Mentor and train new claims processors as needed.

Benefits

• 401(k) with employer matching • Health insurance • Dental insurance • Vision insurance • Flexible Paid Time Off (PTO) • What to Expect Next: • After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.