New Century Health
5h ago
source : TimesJobs

Evolent is looking for bright and energetic individuals to be a Claims Adjudicator Essential functions Experienced level adjudicator providing analytical ability to review claim rules and workflows Responsible for adjudicating claims to maintain / comply with Service Level Agreements Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedures Ability to understand logic of standard medical coding (i.

  • e. CPT, ICD-10, HCPCS, etc.) Research CMS1500 & UB04 claim edits to determine appropriate benefit application utilizing established criteria oApply physician contract pricing as needed Ability to resolve claims that require adjustments and adjustment projects Identify claim(s) with inaccurate data or claims that require review by appropriate team members Maintain productivity goals, quality standards and aging timeframes Contribute positively as a team player Complete special projects as assigned Comply with all departmental and company Policy and Procedures Key competencies / skill / success factors Ability to work in a team environment Integrity and discretion to maintain confidentiality of members, employee and physician data Knowledge of medical billing and coding Knowledge of health insurance, HMO and managed care principles Critical thinking skills and analytical ability to work, discover and outline systems related issues independently and within a team to provide resolution to work products Attention to detail Excellent interpersonal, oral and written communication skills Strong attention to detail and organization Able to work independently;
  • strong analytic skills Strong computer skills

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