Reference #: GUIDUS34452EXTERNALENUS10503
Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.
Benefits info:
Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
Short- and long-term disability benefits
401(k) plan with company match and immediate vesting
Free telehealth benefits
Free gym memberships
Employee Incentive Plan
Employee Assistance Program
Rewards and Recognition Programs
Paid Time Off and Paid Sick Leave
SUMMARY STATEMENT
This position is responsible for entering paper and/or electronic claims into the claims system and examining and determining whether to return, request additional information, deny or pay claims following organizational policies and procedures after entry.
ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
90% of time will be spent on one or more of the following activities depending on assignments:
Accurately examine, interpret and enter claims; resolve edits and first/second level suspense utilizing the claims processing system.
Perform necessary research and effectively make decisions to properly adjudicate claims utilizing processing manual.
Identify and communicate problems relevant to the claims processing system and the processing manual and/or guidelines.
Adhere to all established standard operating procedures.
Support continuous improvement by identifying process improvements and/or quality enhancements.
Initiate and respond to written and verbal communications from internal and external sources.
10% Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
High School Diploma or GED
1 year of data entry experience, including accurate keyboard skills
Proficient with PC's and in Windows based environments; including Microsoft Office (Word, Excel, Outlook)
Demonstrated analytical skills
Strong verbal and written communication skills
Strong interpersonal skills
PREFERRED QUALIFICATIONS
Knowledgeable of medical terminology, procedure and denial codesThe Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
This opportunity is open to remote work in the following approved states: AL,AK, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY.
Specific counties and cities within these states may require additional approval. In FL, PA, TX and WI, in-office and hybrid work may also be available."We are an Equal Opportunity Employer/Protected Veteran/Disabled"Novitas Solutions, Inc. is an Equal Opportunity Employer - Protected Veteran/Disabled