Senior Claims Processor/Auditor

Senior Claims Processor & Auditor

Location: Remote (Texas preferred)

Job Type: Full-time, Non-Exempt

Health Admins is a leading force in healthcare administration, on a journey to become a premier technology-driven healthcare platform. Our vision is anchored in a commitment to Getting Better Every Step of the Way. We are dedicated to providing innovative, efficient solutions that elevate the healthcare experience for the members and clients we serve. We are currently seeking a driven and experienced Senior Claims Processor & Auditor who acts with professional discipline and shares our passion for continuous improvement to join our team.

What We Are Looking For

Our ideal candidate will play a crucial role in managing our Medical Claims environment, optimizing its performance, and driving continuous improvements to support our business goals and enhance our service delivery.

Every Team Member is Driven by a Commitment to Live out These Values:

• Operate as an Owner
• Act with Professional Discipline
• Pursue Progress Through Change
• Treat Service as a Privilege

Employees are expected to embrace our core values by being "A Hero in Action." These values lay the foundation for the way we engage with each other and with our clients. They form the guardrails for our decision making and approach to problem solving.

Summary/Objective:

We are seeking a meticulous and customer-focused individual to join our team as a Senior Claims Processor & Auditor. This role requires a combination of research acumen, attention to detail, and exceptional customer service skills. As a key member of our organization, you will be responsible for processing medical claims accurately, conducting thorough audits to ensure compliance with regulations and policies, and providing excellent service to our clients and healthcare providers.

Key Responsibilities:

• Review and process medical claims submitted by members or providers promptly and accurately.
• Verify the accuracy and completeness of needs information, including patient demographics, diagnoses, procedures, and billing codes when available.
• Ensure compliance with insurance policies and industry standards.
• Investigate and resolve any discrepancies or issues related to claims submissions.
• Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities.
• Analyze claims documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies.
• Research complex medical billing and coding issues to support needs processing and audit activities.
• Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claims adjudication.
• Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy.
• Serve as members' primary point of contact regarding claims inquiries and resolution.
• Respond promptly to customer inquiries and concerns with professionalism and empathy.
• Collaborate with cross-functional teams to address customer issues and ensure timely resolution.

Skills Required:

• Strong knowledge of medical terminology, medical coding, and insurance billing practices;
• Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines;
• Exceptional attention to detail and accuracy in data entry and documentation;
• Effective verbal and written communication skills with a customer-centric approach;
• Ability to work independently and collaboratively in a fast-paced, deadline-driven environment;
• Excellent verbal, written and interpersonal communication skills;
• Must be self-motivator and self-starter;
• Exceptional listening and analytical skills;
• Solid time management skills;
• Ability to multitask and successfully operate in a fast paced, team environment;
• Must adapt well to change and successfully set and adjust priorities as needed;

Education/Experience:

• High School Diploma or equivalent
• Proven experience in medical claims processing, auditing, and healthcare reimbursement.

Technical Knowledge:

• SalesForce Experience
• Google Suite Experience
• Claims Management Software experience

What We Offer:

• Competitive salary and benefits package
• Dynamic and innovative work environment
• Opportunities for professional growth and development
• Remote work

Equal Opportunity Statement

We are deeply committed to building a workplace and global community where inclusion is not only valued but prioritized. We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neuro diversity, disability, age or veteran status, or any other non-merit based or legally protected grounds. We are committed to providing reasonable accommodation to qualified individuals with disabilities in the employment application process.