Immediate need for a talented Claims Processing Executive. This is a 06+months contract opportunity with long-term potential and is located in IOWA(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 26-22885
Pay Range: $19/hr - $20/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
- Core platform QNXT claims experienced - Preferred
- MUST HAVE CLAIMS and FACETS experience
- Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
- Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
- Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
- Documentation: Record claim activity, maintain audit trails, and prepare reports for management.
Key Requirements and Technology Experience:
- High school diploma or equivalent REQUIRED
- Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
- 2 4 years of experience in US healthcare claims processing
- Familiarity with claims management software and EDI transactions.
- Excellent analytical, organizational, and communication skills.
- Ability to interpret insurance policies and payer guidelines.
- Detail-oriented with strong problem-solving abilities.
- Competencies-
- Regulatory Knowledge Deep understanding of US healthcare laws and payer requirements.
- Accuracy & Detail Orientation Ensures claims are processed correctly and efficiently.
- Problem-Solving Resolves claim disputes and denials effectively."
Our client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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