Medicaid Claims Examiner II

• Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader

• Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management

• Mentor junior members of the team

• Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader

• Knowledge base around physician practices and hospital coding, billing and medical terminology, CPT, HCPCS, and ICD-10, UB04, CMS 1500, authorizations, medical terminology, and concepts of healthcare

• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality

• Participate in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities

• High School degree required

• 1 - 3 years healthcare claims processing experience

• Solid understanding and ability to analyse claim data

• ICD-10 CPT and HCPCS coding, is a plus

• Willingness to learn new skills

• Team collaborator

• Strong work ethic

• The ability to adapt quickly to a fast-paced environment

• A self-starter and quick learner

• Team player with an ability to collaborate

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
• Work across multiple time zones in a hybrid or remote work environment.
• Long periods of time sitting and/or standing in front of a computer using video technology.
• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities.