Claims Examiner II
MetroPlusHealth · New York, NY · 2 mo ago
HybridFinanceFull-time
Scope Of Role & Responsibilities
- Process all claims identified as exceeding claim age parameters established within the unit (28+ days)
- Process complex, difficult, and non-routine claims for multiple lines of business
- Audit work of assigned claims examiners to ensure accuracy
- Identify policies of common errors requiring retaining sessions
- Assist with retraining sessions as directed
- Participate in quality projects as required by management
Required Education, Training & Professional Experience
- Bachelor’s degree is required; a Master’s degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency
- At least three (3) years’ experience of claims in a managed care or hospital setting is required
- Strong data entry skills are essential
- In-depth knowledge of adjustment processing, medical terminology, CPT, ICD-P, and revenue codes is required
- Proficiency in Microsoft Office applications, including Word, Excel, and Access, is required
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication