Top 1 Claims processor Jobs in Mount Pleasant, Mi

Healthcare Claims Processor Bakinaw
Migizi EDC —Mount Pleasant, MI
- Temporary
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
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Healthcare Claims Processor Bakinaw
Migizi EDC —Mount Pleasant, MI
Issue Resolution: Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root…
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EFT Processor II
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Healthcare Claims Processor Bakinaw

Migizi EDC -
Mount Pleasant, MI

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Job Details

Temporary | Full-time

Qualifications

Appeals
Microsoft Excel
Microsoft Outlook
Health insurance policy knowledge
Regulatory compliance in claims processing
Word embeddings
Medical coding guidelines
High school diploma or GED
Insurance regulation
Medical insurance appeals management
Medical billing regulations compliance
Insurance claims appeal handling
Medical terminology
Customer service problem-solving

Full Job Description

Bakinaw Federal Contacting is a 100% tribally owned company of Migizi Economic Development Company.

As a tribally owned enterprise, we are proud to create career opportunities that support both our employees and the long-term economic success of the Saginaw Chippewa Indian Tribe.

Job Type

Full-time

Description

Join the new Bakinaw-Karna Joint Venture Team as a Temporary, Full-Time Medical Claims Processor. Become an integral part of a team dedicated to servicing the World Trade Center Health Program. In this role, you will leverage your meticulous attention to detail and commitment to accuracy in processing complex medical claims. If you’re eager to make a positive impact in our community through your administrative skills, we encourage you to apply!

*Minimum of 5 years’ experience in medical claims processing, including professional and facility claims as well as complex and high-dollar claims* Candidates must be located in one of the following states: FL, GA MD, MI, TX

Job Responsibilities:

Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.
Critical Analysis: Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios.
Timely Processing: Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers.
Issue Resolution: Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions.
Confidentiality Maintenance: Uphold the confidentiality of patient records and company information as per HIPAA regulations.
Detailed Record Keeping: Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability.
Trend Monitoring: Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting.
Audit Participation: Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes.
Mentoring: Mentors and trains new claims processors as needed.

Requirements

High school diploma or equivalent.
Minimum of 5 years’ experience in processing medical professional and facility claims as well as complex and high-dollar claims.
Familiarity with ICD-10, CPT, and HCPCS coding systems.
Must have experience working with modifiers and bill types.
Understanding of medical terminology, healthcare services, and insurance procedures (worker’s compensation experience is a plus).
Strong attention to detail and accuracy.
Ability to interpret and apply insurance program policies and government regulations effectively.
Excellent written and verbal communication skills.
Proficient in Microsoft Office Suite (Word, Excel, Outlook).
Capacity to work independently as well as collaboratively within a team.
Commitment to ongoing education and training in industry standards and technology advancements.
Experience with claim denial resolution and the appeals process.
Ability to efficiently manage a high volume of claims.
Customer service-oriented with strong problem-solving capabilities. Must be flexible and have the ability to adjust to the needs of the client and changes in the program.

Apply at the link below:

https://recruiting.paylocity.com/recruiting/jobs/Details/4201120/KARNA-LLC/Experienced-Healthcare-Claims-Processor (https://recruiting.paylocity.com/recruiting/jobs/Details/4201120/KARNA-LLC/Experienced-Healthcare-Claims-Processor)

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Healthcare Claims Processor Bakinaw

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