arge Trade Association for the agricultural field is seeking a Senior Claims Examiner for their Insurance Division. With over 80 years in the industry, this company provides a business casual setting and room to advance. This position is responsible for collaborating with the claims team to meet productively goals and compliance standards. Will be managing a team to ensure commercial and/or hospital claims and examined for plan members in a timely and accurate manner with attention to CMS guidelines and company policies.
Inpatient, Outpatient, Hospital, Medical, and Medicare Claims Processing
Oversee adjudication process
Review claims productively and create/review reports
Answer complex benefits questions
Review complexHospital claims
Create strategic plan for team to improve productivity
Working together in as a team to figure out complicated claim issues and answering questions from claims examiners
The ideal candidate will have:
Medicare/Medi-Cal Claims adjudicating experience
Experience with CPT ICD-9/ICD-10 and Revenue codes
Strong understanding of Medicare guidelines, Health Plan Policies and ICE Compliance guidelines
Experience using Encoder Pro is a plus!