Medical Claims Processor I

Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply.

Work Schedule

• Remote
• Monday through Friday, 8:30 AM to 5:00 PM EST
• Must be able to work 8am - 5pm Eastern Standard Time

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

• Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios.

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

• 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

• Analyze and report trends in claim issues or irregularities to management.
• Assist Team Leads with reporting to contribute to continuous process improvements.

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.

Requirements

• High school diploma or equivalent.
• Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims.
  • 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.

Benefits

• 401(k) with employer matching
• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Flexible Paid Time Off (PTO)
• Paid Holidays