Senior Claims Adjudicator
4 hours ago
Roles and Responsibilities :
- Review and process claims in accordance with established guidelines, regulations, and company policies.
- Conduct thorough reviews of medical records, diagnoses, treatments, and procedures to determine coverage eligibility.
- Identify potential denials and take proactive steps to resolve issues before submitting claims to payers.
- Collaborate with internal stakeholders to ensure accurate coding, billing, and reimbursement processes.
Job Requirements :
- 4-8 years of experience in claims adjudication or related field (e.g., HCPCS).
- Strong understanding of ICD-10-CM/PCS, CPT, HCPCS codes; ability to apply knowledge effectively.
- Proficiency in claims processing software applications such as Epic Systems or similar systems.
- Excellent analytical skills for reviewing complex medical data and making informed decisions.
Interested candidate can share updated resume to
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