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Lead Claims Examiner

Company: Change Healthcare
Location: Topeka
Posted on: June 22, 2022

Job Description:

Overview of Position The Lead Claims Examiner will apply claim processing knowledge to perform internal prepayment quality audit on professional and institutional claims in a managed care setting. They will ensure claims are adjudicated and finalized in accordance with state, federal, and health plan regulatory requirements, and specific client, and department guidelines. Additionally, they will work towards ensuring that established department quality and production performance benchmarks are met. This position is fully remote. What will be my duties and responsibilities in this job?+ Accurately audit professional and institutional claims in accordance with external regulations, internal production standards and contractual obligations in a managed care setting on a prepayment basis. + Experience with claims adjudication on commercial and senior plan claims in a managed care setting on the payer side. Provide support with claims adjudication. + Provide back up as needed to the PDR Specialist and participate in handling complex special projects. + Provide subject matter expertise and support to team members. + Respond to customer service incidents. + Ensure State and Federal regulatory turnaround times are met. What are the requirements needed for this position?+ Required: High school diploma - High school education or higher required + Five or more years of medical claims processing experience + Two or more years of claims auditing or lead experience + Must have 2+ years' experience working the Payor side of claims What other skills/experience would be helpful to have?+ Knowledge of managed care claims processing in a payer environment. + Ez-cap experience preferred. + Familiar with CPT, HCPC, ICD-10, CCI Edit guidelines and medical terminology. + Familiar with CMS-1500 professional and UB-04 institutional claim forms. + Able to meet department production and quality standards. + Familiar with and the ability to understand Provider contracts, Division of Financial Responsibility and COB policies. + Ability to meet position metrics goals. + Maintains confidentiality and discretion regarding all work matters. + Must be able to work independently and be able to effectively prioritize work assignments. Ability to multi-task and meet deadlines. + Adhere to organization policies and procedures What are the working conditions and physical requirements of this job? + Fully Remote + Physical requirements include general office demands Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement. Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system! COVID Vaccination Requirements We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Equal Opportunity/Affirmative Action Statement Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP\_EEO\_Supplement\_Final\_JRF\_QA\_508c.pdf.If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.Click here https://www.dol.gov/ofccp/pdf/pay-transp\_%20English\_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy. California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare's Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) . Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.

Keywords: Change Healthcare, Topeka , Lead Claims Examiner, Other , Topeka, Kansas

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