Job Description
Join a mission-driven healthcare organization dedicated to ensuring accurate claims processing and supporting equitable access to care. This role plays a key part in maintaining financial integrity by analyzing and correcting healthcare claim payments.
Responsibilities:
* Research and analyze medical claims adjustment requests to determine payment accuracy
* Adjust and adjudicate claims using multiple systems and platforms
* Apply appropriate payment guidelines including CMS, Medicare, Medicaid, and internal policies
* Investigate incorrectly processed claims and determine corrective actions
* Communicate findings and coordinate with internal stakeholders as needed
* Respond to provider inquiries regarding claim payments and required documentation
* Process claim adjustments within established timelines
* Maintain up-to-date knowledge of claims processing and coding updates
* Ensure accurate documentation and recordkeeping of all claims...