Job Opportunities in United States
November 15, 2024
TEEMA
Phoenix
FULL TIME & CONTRACT
Claims Reviewer
Claims Reviewer Opportunity
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!
Position Highlights
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!
#BCDC_Consulting
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!
Position Highlights
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Role: Conduct retrospective review of medical, surgical, and behavioral health claims.
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Focus: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.
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Collaboration: Work closely with medical directors, providers, peer reviewers, and various internal teams.
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Review and validate claims using established criteria and processing guidelines.
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Prepare cases for payment or further review.
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Identify opportunities for process improvement and flag quality or fraud concerns.
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Support peers and clinical/non-clinical staff with claims and coding inquiries.
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Required:
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High School Diploma or GED.
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2+ years of experience in medical claims review.
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Familiarity with medical claims processing and terminology.
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High School Diploma or GED.
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Preferred:
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Coding experience.
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Knowledge of behavioral health claims.
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Coding experience.
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Strong technical skills in claims tools (e.g., CDST, Supercoder).
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Organizational and team-building abilities.
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Resilience in a fast-paced, high-intensity environment.
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Effective communication and problem-solving.
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Must pass background, credit, and drug screening.
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Adherence to federal THC policies (medical card required if applicable).
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!
#BCDC_Consulting
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