Claims Adjudication Specialist - job 2 of 3

Job Summary

A company is looking for a Claims Adjudication Specialist.

Key Responsibilities

• Review data in the claim processing system and compare it with corresponding UB or HCFA information
• Assess medical records to determine the appropriateness of services rendered
• Ensure timely handling of designated tasks to meet internal and external SLAs

Required Qualifications

• Minimum of 2 years of claim processing experience
• Knowledge of physician practice and hospital coding, including CPT, HCPCS, and ICD-10
• Experience with UB/institutional and/or professional claims processing
• Familiarity with Medicare/Medicaid payment guidelines and regulations
• High School degree or GED or equivalent experience