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