Remote – Medical Claim Coordinator (CPC Certified)
Job #: 23-02843
Location: Remote – Work from Home
Onsite Flexibility: N/A
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About the Role
In this role, you will be responsible for arbitrating cases, understanding medical claims, and coding determinations, and effectively communicating with various stakeholders, including medical providers and health insurance companies. You will perform a range of tasks to facilitate the resolution of disputes.
We are currently seeking a qualified and experienced Remote – Medical Claim Coordinator (ICD-10 Certified) to join our client's team.
- Review and analyze case file materials related to claims payment disputes.
- Determine if an organizational conflict of interest exists.
- Assess eligibility for review of claims payment disputes.
- Evaluate the completeness of case file materials.
- Identify missing information and collaborate with stakeholders to obtain necessary documentation.
- Apply rules and guidelines to determine the appropriate course of action and document findings.
- Review and analyze medical claims and coding to ensure appropriate coding was applied.
- Gather relevant information from various sources to support the arbitration process.
- Prepare draft payment determinations for review by an Arbitrator/Attorney Reviewer.
- Adhere to all required timelines and maintain high-quality standards in work.
- Utilize multiple systems, such as SharePoint, Salesforce, and Microsoft Office Products, to perform job duties effectively.
- Associate's Degree from an accredited college or university or equivalent experience
- At least two (2) years of experience in a medical billing, claims processing, or related position required
- Experience with ICD-10 and CPT codes.
- Knowledge of medical terminology.
- Certified Professional Coder Certified (CPC)
If you meet the minimum qualifications and are looking for an exciting opportunity in the field of medical billing and claims, we encourage you to apply for this position.