One of our clients, a well-known medical center at a higher education center located in Belmont, is looking for a Fund Medical Claims Adjustor to join their team on a contract basis. The Medical Claims Adjustor will be responsible for supporting the team by the processing of Medicare Preferred claim inventory as assigned by the complex claims supervisor. The Medical Claims Adjustor role is perfect for someone who is detail oriented, has great problem solving skills, loves to do research, is driven, and autonomous.
•Research and resolve complex issues and problem codes so claim can adjudicate.
•Apply product/employer benefit rules to claim for adjudication; and calculate/apply pricing to each claim when necessary.
•Ensure claim payment is updated.
•Answer questions about member’s eligibility.
•Review complex adjustment request to determine re-adjudication of claim.
•Examine and adjust claims data as necessary.
•Research provider payment inquires related to contract pricing, medical coding, and pricing edits.
•Monitor pending claims and adjustments.
•Serve as SME for documentation, projects, and testing.
•Assist team members as needed.
•Apply company policies and guidelines through all processes.
•2+ years of experience claims processing
•Bachelor’s Degree or equivalent.
•An interest in science and health care.
•Experience working in a fast-paced environment.
•Problem solving, analytical skills and attention to detail are desired.
•Knowledge of managed care concepts and strong understanding of CPT, ICD-9 (ICD-10), HCPCS coding guidelines, and CM1500 AND UB04 billing forms would be a plus.