Healthfirst

The Claims Examiner will be responsible for processing complex medical and facility claims accurately through Healthfirst’s claims processing system. This is a fast-paced and high volume environment. The Claims Examiner will be expected to maintain production and quality standards as they process and adjudicate daily claims. This is a team environment position. The Claims Examiner must be able to effectively work with others, provide and implement claims processing solutions while understanding process flows. At the discretion of the Claims Manager, this position will transition into a telecommuting role (full time) following an initial training period.

•Review, investigate and adjudicate claims and encounters for medical services through contractual provisions in accordance with provider contracts and authorizations.
•Process new claim suspensions and perform claim adjustments to correct erroneous payments (overpayments/underpayments) as well as review other documentation for edits and consistency. All errors must be documented according to Healthfirst policies and procedures.
•Complete Special Projects as required and as directed by Manager or Director
•Absorb, retain and apply wide range of information about the company policies, procedures and benefits.
•Meet individual and department standards with regards to both quality and productivity goals.
•Additional duties as assigned

Minimum Qualifications:

- Experience within a medical claims billing environment where you have processed and adjudicated medical or facility claims. 

- Experience working with multiple Excel spreadsheets which will include filtering and updating information on a daily basis. 

- Competency with navigating a keyboard and ability to enter data with speed and accuracy. 
- Prior experience managing high volume claims workload. This is a fast paced environment.

- The Claims Examiner will be expected to meet individual and departmental standards with regards to quality and productivity. 

- High School diploma or GED from an accredited institution.

Preferred Qualifications:

- Associate's degree or higher from an accredited institution.

- ICD-10/Coding Certificate.

- The ability to type 40 + WPM.

- Knowledge of medical terminology, ICD-10, CPT-4 and Healthcare Common Procedure Coding System (HCPCS)

- Experience working in premium billing, COBRA administration, flexible spending and disability processing.

- Experience processing and adjudicating claims for commercial health insurance companies, managed care organizations or other healthcare related field.

- Familiarity with commercial insurance plans and/or Medicaid, Medicare, healthcare exchange rules and regulations.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960

• All Other Locations (within approved locations): $42,200 - $62,400

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.