Claims Adjudication Specialist

Job Summary

A company is looking for a Claims Adjudication Specialist to manage the adjudication of claims remotely.

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 tasks to meet internal and external service level agreements (SLAs)

Required Qualifications and Education

• A minimum of 2 years of claim processing experience is required
• Knowledge of physician practice and hospital coding, including CPT, HCPCS, and ICD-10
• Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims
• Knowledge of Medicare/Medicaid payment guidelines and regulations
• High School degree or GED or equivalent experience