Claims Examiner Support Role at Molina Healthcare Orlando FL
Overview
Support claims examination activities by evaluating adjudication outcomes to identify coding errors fraudulent billing practices waste overpayments and processing mistakes. Drive proactive identification of defect reduction strategies through trend analysis and recommend solutions to enhance claims processing efficiency. Meet quality standards while supporting departmental initiatives to improve operational effectiveness.
What You'll Do8
- 1Evaluate claim adjudication using established principles and state regulations to detect incorrect coding abuse and fraudulent billing practices waste overpayments and claims processing errors
- 2Procure comprehensive medical records and supporting statements for each claim case
- 3Provide recommendations for further investigation or resolution of identified issues
- 4Reduce defects through proactive error identification during pre-payment stages and suggest corrective measures
- 5Maintain compliance with claims department quality and production standards
- 6Assist with assigned claims projects and prioritize tasks to meet internal deadlines
- 7Collaborate with claims team to improve overall function efficiency
- 8Complete basic claims projects as directed by supervisors
Requirements7
- 1Minimum 1 year experience in claims or customer service roles preferably within managed care settings
- 2Strong data entry research and organizational skills with attention to detail
- 3Excellent time management abilities and capacity to handle multiple projects simultaneously
- 4Proven customer service expertise with effective verbal and written communication capabilities
- 5Proficiency in Microsoft Office suite and relevant software applications
- 6Health care claims billing experience preferred
- 7Bold certifications: CPC Card BCBA AWS Certified
Salary Insight
$29 - $54k per year
Location
Required Skills
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