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 that CHP serves the needs of each unique partnership while prioritizing best healthcare 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. The position requires a strong understanding of healthcare terminology, claims systems, and payer guidelines , including Medicare, Medicaid, and commercial insurance. Collaborates with other departments in refining/improving processes. Provides feedback to the supervisor on trends and issues observed as opportunities for process improvement. Provides customer service for incoming and outgoing inquiries. Applicants must live in CO, UT, Fl, TX, OR, TN, MO, SD, OH, MT, IL, Qualifications (Education/Experience/Knowledge/Skills/Abilities): High School Diploma/GED Three to five years’ experience working in a managed healthcare environment. Minimum of two years of combined experience processing healthcare claims/appeals or adjudication. Knowledge of medical terminology, CPT/ ICD-10/HCPC coding, and EOB/EOP interpretation. Proficiency in claims processing systems Attention to detail and accuracy Time management and prioritization Critical thinking and decision-making Written and verbal communication Team collaboration and adaptability Understanding of HIPAA and confidentiality protocols 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 offers 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 are available. Paid time off, up to 28 days per year based on tenure and position. Paid holidays: We recognize 11 holidays. Education tuition reimbursement. Compensation Range: $23.00 - $27.00 hourly 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. #J-18808-Ljbffr