|Location:|| Birmingham 35216, AL, US
NaphCare, Inc. has an excellent opportunity for a Sr. Claims Adjudicator (Claims Examiner Tier II, Claims Analyst Tier II) to join our team at the Corporate Headquarters in Birmingham, Alabama.
The Sr. Claims Adjudicator will be responsible for reviewing medical claims for accuracy and completeness, analyzing complex CCI and CMS edits, making determinations on claims based on established policies and procedures and processing claims for payment. The ideal candidate will have strong knowledge and experience in processing multiple claim types, including professional, institutional and dental claims.
- Utilize claims processing experience and working knowledge of Medicare and Medicaid to effectively and efficiently process claims for payment while adhering to internal deadlines.
- Demonstrate ability to handle daily workload with speed and accuracy.
- Demonstrate a high comfort level in working with large volumes of data.
- Demonstrate the ability to act as a mentor for others within team.
- Demonstrate a strong attention to detail and a commitment to customer service throughout the claims process.
- Additional duties and specific projects as assigned.
- Associate Degree or higher or equivalent work experience.
- Minimum five years of recent adjudication experience required.
- An ability to define and calculate Medicare and Medicaid is critical.
- Working knowledge of medical terminology, billing standards, and Medicare and Medicaid methodologies.
- Proficiency in Microsoft Office Suite and strong written and verbal communication skills are also required.
- CPC, COC, CIC, or Specialty Medical Coding Certification preferred.
**This is not a remote position at this time.
Equal Opportunity Employer: disability/veteran
Outstanding Benefits Package:
NaphCare offers competitive benefits, including health, prescription, dental, Employment Assistance Program (EAP) services, vision and 401(k). NaphCare offers term life insurance at no cost to the employee and provides PTO, paid holidays and an array of voluntary benefits. Employees enrolled in our health insurance program receive prescriptions free of charge when filled at our in-house pharmacy or mail order program.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with a job