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For your reference, we have included the original job posting below.
Claims Adjudicator II
Job Number:
44933921
Company Name:
Health Sun
Job Location:
Coconut Grove, FL US
Job Categories:
Insurance Healthcare & Medical
Minimum Education:
High School Diploma
Claims Adjudicator II
Position: Claims Adjudicator II
Essential Duties and Responsibilities
Analyze, process, research, adjust and adjudicate Medicare Part A Hospital claims with the use of accurate procedure/revenue and ICD-9 codes.
Analyze, process, research, adjust and adjudicate Medicare Part B claims.
Check for erroneous items or codes and missing information and correct according to established procedures.
Data enter and/or
Verify data entry for accuracy and completeness.
May provide office support as necessary.
Requirements:
Requirements:
Minimum of 4 years experience in processing and adjudicating Medicare Risk claims.
At least 3 years of experience with Medicare Part A hospital claims within the managed care industry.
Familiarity with ICD-9, HCPCS, CPT coding, modifiers and APC and DRG pricing, CMS, DMHC regulations, facility and professional claim billing practices.
Education and Typical Years of Experience: High School diploma or equivalent. Knowledge of claim types HCFA/CMS & UB. Insurance experience: Medicare and Medicaid a must. EDI claims processing experience.
We offer good benefits, excellent compensation and a collegial work environment. E-mail us your resume in Word Document Format. AA/EOE We support a drug free workplace.
