Medical Claims Examiner

Location: Phoenix, AZ, United States
Date Posted: 07-27-2018
DSNP Medicare Claims Examiner

 Processing basic payments and/or claim denials for group health which includes medical, dental, vision, FSA, HSA, HRA and disability benefits; demonstrating the highest levels of customer service, technical skills and professionalism to ensure mutually rewarding and continued provider relationships.

Responsibilities Include:
·         Examining and entering basic DSNP Medicare claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
·         Processing DSNP Medicare claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
·         Approving, pending, or denying payment according to the accepted coverage guidelines.
·         Identifying and referring all DSNP Medicare claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files).
·         Maintaining internal customer relations by interacting with staff regarding DSNP Medicare claims issues and research, ensuring accurate and complete DSNP Medicare claim information, contacting insured or other involved parties for additional or missing information, and updating information to DSNP Medicare claim file with regard to claims status, questions or DSNP Medicare claim payments.

Qualifications Include:
·         High school diploma, GED Certificate or equivalent.
·         Minimum of 2 year of DSNP Medicare Claims Experience with or certification in QicLink preferred.
·         Knowledge of medical terminology including CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines.

Interested candidates, email your resume to
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