Imagenet is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data validation, adjudication and on demand retrieval of documents and data.
Job Description:
- Design, develop, and execute a dynamic claims training program
- Responsible for new Claims Analyst training and auditing of trainee claim processing
- Analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling
- Follow claims adjudication process to assure that all claims are adjudicated in accordance with CMS rules and regulations in conjunction with the client company guidelines
- Review Medicare, Medicaid and Commercial services for appropriateness of charges and will apply pre-existing guidelines during claims processing
- Pend claims and order Medical records for review and investigation of possible gross misrepresentation
- Authorize claim payments within established limits; otherwise forward to Claims Manager
- Process refunds and letters of dual coverage (when applicable);
- Identify process improvement opportunities within the claim department and recommend system enhancements
- Handles any additional responsibility which may be assigned
Education:
- High School Diploma or equivalent required
- AS / BS Degree Preferred
Experience:
- Three to Five years’ experience working in a claims or claims processing environment required
- One to Three years training experience preferred
Technical Skills / Knowledge:
- Understanding of health claims processing
- Ability to perform basic to intermediate mathematical computation routines
- Medical terminology strongly preferred
- Understanding of ICD-9 & ICD-10
- Basic MS office computer skills
Other Skills:
Ability to work independently or within a team
Time management skills
Written and verbal communication skills
Attention to detail
Must be able to demonstrate sound decision making skills
Location: Remote in Tampa, FL
Hours: Monday - Friday, 8 hours per day
Pay: $20-$26 per hour, DOE
COMPANY OVERVIEW
Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers.
The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers. The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually. The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance, and automation of claims operations for its clients.
Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.
Imagenet LLC provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training
