Claims Processing Executive

Healthcare Claims Processing Executive (QNXT Claims)

Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts, allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing, enhancing customer satisfaction and operational excellence.

Roles & Responsibilities:

• Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
• Work on the QNXT claims platform (Required).
• Verify patient eligibility, coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
• Approve, deny, or adjust claims based on payer guidelines and policy terms.
• Maintain compliance with HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
• Record claim activity, maintain audit trails, and prepare reports for management.
• Utilize MS Excel for claims tracking, reporting, and analysis.

Required Skills:

• QNXT Claims Processing (Required)
• Healthcare Claims Processing
• Commercial Claims
• Medicare
• Medicaid
• Commercial Insurance
• Claims Adjudication
• Eligibility Verification
• HIPAA Compliance
• CMS Guidelines
• EDI Transactions
• Claims Management Software
• MS Excel
• Insurance Policy Interpretation
• Analytical & Problem-Solving Skills
• Strong Communication Skills
• Detail-Oriented

Qualifications:

• High school diploma or equivalent (Required).
• 24 years of experience in US healthcare claims processing.
• Strong knowledge of US healthcare insurance systems, including Medicare, Medicaid, and commercial payers.
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational, and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Detail-oriented with strong problem-solving abilities.
• Must be a resident of Iowa.
• Must be comfortable with a 36 month contract.