Medical Claims Processor I

<div class="content-intro"><div class="et_pb_module et_pb_text et_pb_text_0 et_pb_text_align_left et_pb_bg_layout_light"> <div class="et_pb_text_inner"> <p style="text-align: justify;">At <strong>Broadway Ventures</strong>, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.</p> </div> </div></div><p> </p> <p class="" data-start="272" data-end="617">Become an integral part of a dedicated team supporting the World Trade Center Health Program. In this role, you will leverage your strong attention to detail and commitment to accuracy in processing complex medical claims. If you are eager to make a positive impact in the community through your administrative skills, we encourage you to apply.</p> <p class="" data-start="619" data-end="638"><strong data-start="619" data-end="636">Work Schedule</strong></p> <ul> <li data-start="641" data-end="707">Remote</li> <li data-start="710" data-end="751">Monday through Friday, 8:30 AM to 5:00 PM EST</li> <li data-start="710" data-end="751">Must be able to work 8am - 5pm Eastern Standard Time</li> </ul> <h2 class="" data-start="753" data-end="772">Responsibilities</h2> <p class="" data-start="774" data-end="808"><strong data-start="774" data-end="806">Claims Review and Processing</strong></p> <ul data-start="809" data-end="952"> <li class="" data-start="809" data-end="952"> <p class="" data-start="811" data-end="952">Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.</p> </li> </ul> <p class="" data-start="954" data-end="977"><strong data-start="954" data-end="975">Critical Analysis</strong></p> <ul data-start="978" data-end="1095"> <li class="" data-start="978" data-end="1095"> <p class="" data-start="980" data-end="1095">Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios.</p> </li> </ul> <p class="" data-start="1097" data-end="1120"><strong data-start="1097" data-end="1118">Timely Processing</strong></p> <ul> <li data-start="1123" data-end="1210">Ensure prompt claims processing to meet client standards and regulatory requirements.</li> <li data-start="1213" data-end="1290">Identify and resolve any barriers using effective problem-solving strategies.</li> </ul> <p class="" data-start="1292" data-end="1314"><strong data-start="1292" data-end="1312">Issue Resolution</strong></p> <ul> <li data-start="1317" data-end="1405">Collaborate with internal departments to proactively resolve discrepancies and issues.</li> <li data-start="1408" data-end="1478">Use analytical skills to identify root causes and implement solutions.</li> </ul> <p class="" data-start="1480" data-end="1513"><strong data-start="1480" data-end="1511">Confidentiality Maintenance</strong></p> <ul data-start="1514" data-end="1619"> <li class="" data-start="1514" data-end="1619"> <p class="" data-start="1516" data-end="1619">Uphold confidentiality of patient records and company information in accordance with HIPAA regulations.</p> </li> </ul> <p class="" data-start="1621" data-end="1650"><strong data-start="1621" data-end="1648">Detailed Record Keeping</strong></p> <ul data-start="1651" data-end="1756"> <li class="" data-start="1651" data-end="1756"> <p class="" data-start="1653" data-end="1756">Maintain thorough and accurate records of claims processed, denied, or requiring further investigation.</p> </li> </ul> <p class="" data-start="1758" data-end="1780"><strong data-start="1758" data-end="1778">Trend Monitoring</strong></p> <ul> <li data-start="1783" data-end="1859">Analyze and report trends in claim issues or irregularities to management.</li> <li data-start="1862" data-end="1944">Assist Team Leads with reporting to contribute to continuous process improvements.</li> </ul> <p class="" data-start="1946" data-end="1971"><strong data-start="1946" data-end="1969">Audit Participation</strong></p> <ul> <li data-start="1974" data-end="2073">Engage in audits and compliance reviews to ensure adherence to internal and external regulations.</li> <li data-start="2076" data-end="2146">Critically evaluate and recommend process improvements when necessary.</li> </ul> <p class="" data-start="2148" data-end="2163"><strong data-start="2148" data-end="2161">Mentoring</strong></p> <ul> <li data-start="2166" data-end="2215">Mentor and train new claims processors as needed.</li> </ul> <h2 class="" data-start="2217" data-end="2232">Requirements</h2> <ul> <li data-start="2236" data-end="2270">High school diploma or equivalent.</li> <li data-start="2273" data-end="2425">Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims. <ul> <li data-start="2273" data-end="2425">Billing experience doesn't count towards years of experience qualification</li> </ul> </li> <li data-start="2428" data-end="2483">Familiarity with ICD-10, CPT, and HCPCS coding systems.</li> <li data-start="2486" data-end="2627">Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker’s compensation claims is a plus).</li> <li data-start="2630" data-end="2670">Strong attention to detail and accuracy.</li> <li data-start="2673" data-end="2770">Ability to interpret and apply insurance program policies and government regulations effectively.</li> <li data-start="2773" data-end="2823">Excellent written and verbal communication skills.</li> <li data-start="2826" data-end="2887">Proficiency in Microsoft Office Suite (Word, Excel, Outlook).</li> <li data-start="2890" data-end="2966">Ability to work independently and collaboratively within a team environment.</li> <li data-start="2969" data-end="3073">Commitment to ongoing education and staying current with industry standards and technology advancements.</li> <li data-start="3076" data-end="3140">Experience with claim denial resolution and the appeals process.</li> <li data-start="3143" data-end="3197">Ability to manage a high volume of claims efficiently.</li> <li data-start="3200" data-end="3276">Strong problem-solving capabilities and a customer service-oriented mindset.</li> <li data-start="3279" data-end="3357">Flexibility to adjust to the evolving needs of the client and program changes.</li> </ul> <p><strong>Benefits</strong></p> <ul> <li data-start="3374" data-end="3403">401(k) with employer matching</li> <li data-start="3406" data-end="3422">Health insurance</li> <li data-start="3425" data-end="3441">Dental insurance</li> <li data-start="3444" data-end="3460">Vision insurance</li> <li data-start="3463" data-end="3477">Life insurance</li> <li data-start="3480" data-end="3508">Flexible Paid Time Off (PTO)</li> <li data-start="3511" data-end="3524">Paid Holidays</li> </ul> <p> </p><div class="content-conclusion"><p></p> <p data-start="1731" data-end="1755"><strong data-start="1731" data-end="1755">What to Expect Next:</strong></p> <p data-start="1757" data-end="2185">After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.</p> <p data-start="2187" data-end="2478">Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.</p> <p data-start="2480" data-end="2658">Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).</p> <p></p> <p></p></div>