Medical Claims Adjudicator

Job Title:  Medical Claims Adjudicator
Location: Remote
US Citizen: Yes
Security Clearance: N/A

 Apprio is an innovator of specialized technology and program solutions for the federal health, defense, and homeland security markets. The company provides services in technology transformation, organizational excellence, health IT & solutions, emergency response management, and international development. Apprio delivers the methodologies, discipline and expertise provided by the large integrators, with the cost structure and collaboration offered by smaller firms. Year after year we have continued to experience impressive growth due to our holistic approach in delivering solutions, thought leadership, and synergistic teams to address our client’s needs.
    

Job Description:
Apprio is seeking a Medical Claims Adjudicator. This position will serve as a resource for claims future cost, auditing reimbursement valuation and appeals of medical claims using Medicare rules as a guideline. The successful candidate will have working knowledge of Excel, demonstrated attention to detail, general claims handlings, strong written and verbal communications skills, ability to review and analyze claims and ability to work in a high paced environment.   

 Responsibilities:   

• Analyzes and reviews claims received from a variety of sources for accuracy and compliance with provider contracts in place; 
• Prepare claim authorizations in coordination with client referrals;
• Estimate future claim costs for an episode of care through clinical information, past experience and use of claim management software;
• Receive, process, and calculate claims payments in coordination with review of claim authorizations;
• As necessary, request and receive additional documentation from client representative; 
• May receive phone/email inquiries from client representatives and respond in a concise and professional manner;  
• Investigates discrepancies and resolves in accordance with pricing rules and program requirements; 
• Process claims for payment recommendation in accordance with internal procedures; 
• Review electronic claims and/or perform logging and data entry using a medical bill repricing software and web-based tools as needed;
• May conduct post adjudication audits of claims to ensure that they are adjudicated in accordance with program requirements;  
• Assist in the compilation of statistics to support management reporting
• Request and track the collection and storage of provider medical records as required by the program
       

Educational Requirement:  High school diploma or GED
Certification Preferred: Billing and / or Coding
Required Experience: 5+ years of experience
    

Requirement Knowledge:  

• Strong attention to detail 
• Exceptional knowledge of Medicare billing and reimbursement requirements
• Must demonstrate strong understanding of federal HIPAA laws 
• Experienced in the use of medical claims payment and pricing systems 
• Exceptional analytical/problem solving skills  
• Excellent organizational skills  
• The ability to meet deadlines, prioritize and be flexible 
• The ability to keep a clear focus with interruptions 
• General knowledge of medical terminology and the provision of medical services  
• Proficient in MS Office products including Word, Excel and Power Point 
• Demonstrated ability to organize and analyze complex data and present in a meaningful manner
       

Preferred Knowledge:  

• Excellent communication skills (both oral and written) 
• Ability to manage multiple tasks simultaneously. 
• Must function successfully in a team environment. 
• Ability to “learn on the fly” 
• Strong customer orientation 
• Self-starter, able to work effectively with minimal supervision 
• Able to function effectively in a rapidly changing work environment and comfortable working within unstructured work settings  

Apprio offers a collegial and supportive environment focused on its greatest assets…its people.  With a competitive compensation and benefits program designed to attract, motivate, and develop our people; we pride ourselves on creating a culture of teamwork, client focus, and fun.  Our benefits program allows our employees to select the features that make the most sense for their individual and/or dependent(s) needs.  Features include medical, prescription drug, dental, vision, disability, retirement savings, and a competitive paid time off program.  Apprio is an equal employment opportunity company. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.

Privacy & Fraud Notice:
Apprio is committed to protecting the privacy and security of all job applicants. Please be aware of fraudulent recruiting activity that may attempt to impersonate Apprio or its employees. Apprio will never request payment, personal financial details, or conduct interviews via text or social media. All official communications come from an @apprio.com email address or within the career site of the job posting. If you suspect fraudulent activity, please contact https://apprio.com/contact-us/