Medical Claims Adjudicator

Job Summary

A company is looking for a Medical Claims Processor to ensure accurate and timely adjudication of claims.

Key Responsibilities

• Review claim system data and verify against UB or HCFA information
• Evaluate medical records for service appropriateness and compliance
• Manage tasks within designated timelines to meet SLAs

Required Qualifications

• A minimum of 2 years' claims processing experience
• Knowledge of medical coding and terminology, including CPT, HCPCA, and ICD-10
• Experience with UB/institutional and/or professional claims processing
• Knowledge of Medicare/Medicaid payment guidelines and regulations
• High School degree or GED or equivalent experience