Claims Examiner

POSITION SUMMARY / RESPONSIBILITIES

Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children’s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department.

EDUCATION / EXPERIENCE

High school diploma or GED equivalent is required. Two or more years of experience claim processing and / or billing experience required. Specific knowledge and experience in Medicaid, CHIP and commercial claim processing preferred. Knowledge of ICD-9, CPT 4 coding and medical terminology is required.