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Job Description

• Support a remote claims processing team, including coordination with an offshore team based in India.

• Assisting with end-to-end claims process, ensuring accuracy, timeliness, and compliance.

• Assist with Processing & Review on complex claims, including Physician and Facility claims.

• Provide expert guidance on CPT codes, UB04s, HICFA forms, DRGs, ICD-10, and appeals.

• Address and resolve escalated claims issues and inquiries.

• Collaborate with internal teams via Microsoft Teams, phone, and email.

• Maintain documentation and reporting for claims activities and quality metrics.

Communicate to Claims Leadership any issues that would impede the accurate and timely processing of claims.

We are a company committed to creating inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity employer that believes everyone matters. Qualified candidates will receive consideration for employment opportunities without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, disability, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to Human Resources Request Form (https://airtable.com/app21VjYyxLDIX0ez/shrOg4IQS1J6dRiMo) . The EEOC "Know Your Rights" Poster is available here (https://www.eeoc.gov/sites/default/files/2023-06/22-088\_EEOC\_KnowYourRights6.12ScreenRdr.pdf) .

To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/ .

Skills and Requirements

Must have high school diploma or GED, degree preferred

• 10+ years of Medicare claims processing experience with knowledge of CPT4 and ICD10 codes, UB04s and HCFA Forms

• Strong knowledge of Physician and Facility Claims, Audit Codes and Billing, DRGs and ICD-10, Appeals Processes

• Proven experience in a leadership, supervisory or quality assurance role.

• Working knowledge of Medicare medical insurance terminology, procedure, diagnosis codes, fee schedules and HIPPA requirements

• Experience interacting with clients and building professional relationships.

• Preferred background in government contracts, correctional facilities or healthcare facilities.

- experience with Excel -Degree

-Experience working with or within the prison system, including federal, county, or state correctional facilities.

-Background in non-commercial insurance claims (e.g., government-funded programs, correctional healthcare, etc.).

-experience working with an offshore team null

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion,sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military oruniformed service member status, or any other status or characteristic protected by applicable laws, regulations, andordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [email protected].