Claims Adjudicator II

Job Summary: Claims Adjudicator II is responsible to review and accurately process medical facility and/or dental claims for all lines of business. Essential Functions: Adjudicate all levels of claim edits including complex claim pends, manual pricing, manual COB computation, corrected claims, and claim adjustments Research and Resolve claims with error messages by researching and correcting codes, units, etc. Ensure proper benefits are applied using appropriate operating procedures and processes Meet production and quality standards for claim processing and payment Research and resolve claim processing issues including but not limited to certain Provider inquiries, special projects, and testing Perform any other job duties as requested Education and Experience: High School Diploma or equivalent required Post-secondary academic coursework, degree, or certification in Healthcare related field is preferred Minimum of two (2) year of medical insurance claim adjudication experience is required One (1) year recent CareSource Claim Adjudication experience preferred Competencies, Knowledge and Skills: Basic computer skills with Excel and Outlook Intermediate level experience performing data entry functions. Medical terminology: CPT-4 and ICD-10 coding knowledge required Ability to work independently and within a team Attention to detail Ability to remain focused in a production environment Knowledge of multiple products and reimbursement methodologies Time management skills Decision-making and problem-solving skills Written and oral communication skills Research skills Knowledge of billing practices Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Flexibility to meet training schedules within standard scheduled hours Some weekends may be required based on business needs Organization Level Competencies Leveraging Feedback Customer Orientation Valuing Differences Managing Work Earning Trust Quality Orientation Adaptability Influencing Collaborating This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.