Healthcare Claims Investigator

  • Company: Adecco
  • Location: Wilkes-Barre, Pennsylvania
  • Posted: January 12, 2017
  • Reference ID: 51977157
Adecco is currently recruiting for healthcare claims analysts in the Wilkes Barre area. Candidates should have the following experience:

-A minimum of 2 years of Healthcare (Medical) Claims Experience
-Must be able to process claims
-Must be able to research claims (why denied, why not paid)
-Must be able to process appeals from denied claims

The position involves business to business claim collections, knowledge of claims processing for appeals and resubmissions, including claim form types. Receives incoming calls to Service Bureau providing customer service to a variety of clients. Responds to inquiries regarding the outpatient claims billing status in an accurate, timely and non-biased manner. Reviews/reconciles/completes calls, tasks and patient accounts within the respective financial class in a timely and accurate manner.

Candidates need to know what a claim looks like and know the difference between:

-CMS1500 (HCFA-1500 (aka CMS 1500) is a medical claim form employed by individual doctors & practices, nurses, and professionals, including therapists, chiropractors, and out-patient clinics. It is not typically hospital oriented.)
-UBO4 (UB-04 (aka CMS 1450) is a claim used by hospitals, nursing facilities, in-patient, and other facility providers.)

-Candidates need to be familiar with HCPCS (¿Hicks-Picks¿) ¿ Healthcare Common Procedure Coding System ¿ ICD9 or ICD10 codes
-CPC (Certified Professional Coder) Certification helpful, but not needed
-Need to be HIPPA familiar
-Strong Team Player personality
-Independent Thinker
-Change Advocate
-Strong Analytical and Research Skills
-DME (Durable Medical Equipment) knowledge

The Role can include both phone queue (must be articulate in speech and able to pronounce and annunciate properly) as well as heavy email correspondence and web chat.
This position is Monday-Friday, 8 am to 4:30 pm with Optional OT once goals have been met and maintained. It is temp-to-hire. Candidates are eligible for permanent hire after 3-4 months. The position pays $16 per hour to start. Base salary decreases to $14 after permanent hire, but you are then eligible for bonuses and incentives, plus a wonderful benefits package and paid time off.
Qualified? Don¿t miss out on this great opportunity! Apply directly to this job posting or by logging onto and click APPLY NOW. Please make sure to upload your resume to the application. All candidates will be contacted in a timely manner. Equal Opportunity Employer Minorities/Women/Veterans/Disabled

Share this Job