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Medicaid Claims Examiner II
HealthEdge. Process assigned claims based on client-specified guidelines or team-leader direction .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare claims processing, including knowledge of CPT, HCPCS, and ICD-10 coding. Capable of analyzing claim data and ensuring compliance with financial and procedural accuracy standards while mentoring junior team members.
Highest-signal resume keywords
Healthcare Claims Processing ExperienceCPT CodingHCPCS CodingICD-10 CodingClaims Data Analysis
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ProcessingCPT CodingHCPCS CodingICD-10 CodingClaims Data AnalysisMedical TerminologyBillingCodingAuthorization KnowledgeHealthcare Concepts
Soft Skills
Team CollaborationStrong Work EthicAdaptabilitySelf-StarterQuick Learner
Industry Keywords
Claims Processing SystemAdjudication SystemProvider DataEnrollmentQuality Audits
About the role
Key responsibilities & impact- Process assigned claims based on client-specified guidelines or team-leader direction
- Meet productivity targets and financial and procedural accuracy standards
- Review claims-processing-system data to determine whether services were appropriate and benefit coverage criteria were met
- Review adjudication system edits to determine whether to pay claims and/or line items
- Mentor junior team members
- Collaborate on special projects, including process documentation, training, quality audits, and surge activity
- Communicate with management about issues and concerns and take preventive measures to ensure processing accuracy and quality
- Participate in projects involving provider data, authorizations, enrollment, or other activities
- Report to the Claims Team Leader
Requirements
What you’ll need- High School degree required
- 1–3 years healthcare claims processing experience
- Solid understanding and ability to analyse claim data
- Knowledge of physician practices and hospital coding, billing, and medical terminology
- Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, authorizations, and healthcare concepts
- ICD-10, CPT, and HCPCS coding is a plus
- Willingness to learn new skills
- Team collaborator
- Strong work ethic
- Ability to adapt quickly to a fast-paced environment
- Self-starter and quick learner
- Team player with ability to collaborate
- Candidates may be required to complete a pre-employment criminal background check
Benefits
Comp & perks- Remote work environment
- Hybrid or remote work environment across multiple time zones
- May require travel dependent on company needs
- Reasonable accommodations for individuals with disabilities
- Equal opportunity employer committed to workforce diversity