Claims Examiner

CLAIMS EXAMINER:

Correctional Health Partners (CHP) specializes in customized third-party administrative (TPA) services. We develop strong working relationships with hospitals and providers with a focus on trust, compassion, and integrity. Our teamwork driven services ensure CHP serves the needs of each unique partnership while prioritizing healthcare best practices.

We are looking for a Claims Examiner to process provider and facility claims according to the fee schedule / rates specified within the provider’s contracts, while applying the restrictions contained in the benefit plan and coding guidelines. Verifies eligibility and authorization prior to adjudication. Manages workflow to maintain turnaround time requirements. Adjudicates claims within Quality Assurance standards. Collaborates with other departments in refining / improving processes. Provides feedback to supervisor on trends and issues observed as opportunities for process improvement. Provides customer service for incoming and outgoing inquiries.

Applicants must live in CO, PA, IL, AR or OR

Qualifications (Education/Experience/Knowledge/Skills/Abilities):

• High School Diploma/GED
• Three to five years’ experience working in a managed healthcare environment.
• Minimum of one-year combined experience processing healthcare claims / appeals.
• Knowledge of medical terminology, ICD-9 coding, CPT coding, HCPC coding.
• Must adhere to CHP’s five core values:
• Integrity: To do the right thing, even when nobody is watching.
• Teamwork: To collaborate and to support each other in achieving a common goal.
• Accountability: To take responsibility for our successes and failures, and to hold ourselves and others to high-standards.
• Patient-centered: To identify patient needs and provide optimal patient care.
• Compassion: To be empathetic toward the needs of our clients, patients, and coworkers.
  

Correctional Health Partners offer a professional atmosphere, competitive salaries and a full range of benefits. Benefits we provide include:

• 401(k) plan.
• Medical, dental, and vision benefits.
• Flex spending, medical and dependent care plans available.
• Paid time off, up to 28 days per year based on tenure and position.
• Paid holidays: we recognize 9 holidays.
• Education tuition reimbursement.
• Exercise incentive program.
  
  
  

Correctional Health Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.