Healthcare Claims Adjudicator/Tampa with Possibility of Remote Work

Imagenet is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. We are looking for Claims Examiners to join our rapidly growing team in Tampa. Experience is preferred but not necessary. Candidates with the right aptitude and desire to learn will be given the required training to be successful. We are excited for this limited opportunity to train candidates that have a phenomenal work ethic and want to learn a new trade. You will receive in-depth training on industry standards, coding, and metrics. Please apply if you exhibit the focus and desire to do great things!

We offer great benefits, flexible hours, and the opportunity for remote work for self-disciplined candidates who can perform well under limited supervision. Imagenet offers unlimited opportunities for candidates looking for upward mobility. Our leaders are always promoted from within and there is not a minimum employment time frame if you qualify for promotions. We appreciate referrals and always look to reward employees who help us grow.

MUST BE LOCAL TO TAMPA

Do not apply if you are not local to Tampa

This position is based in our Tampa office. However, employees who consistently meet performance metrics are eligible for a flexible work arrangement that allows working from home. To qualify, employees must:

1. Consistently meet or exceed all productivity and quality metrics for their role over a 3-month period
2. Demonstrate the ability to collaborate effectively and maintain strong communication with team members while working remotely
3. Have no active performance improvement plans or disciplinary issues
4. Once the above criteria are met, the employee may submit a request to work from home up to 2 days per week. Approval will be at the manager's discretion based on business needs and the employee's proven performance.
5. Any decrease in productivity or engagement may result in the flexible arrangement being discontinued.

We strive to provide flexibility where possible to employees who have demonstrated success in their role. This policy is subject to ongoing review and may be updated or discontinued based on business requirements.

Job Description

• Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services
• Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria
• Review different lines of business to include Medicare, Medicaid and Commercial services adherence to the contracts and timeliness guidelines
• Authorize claim payments within established limits; otherwise forward to Claims Manager
• Potentially process refunds appeals, disputes and adjustments (when applicable)
• Identify process improvement opportunities within the claim department and recommend system enhancements
• Handles any additional responsibility which may be assigned

Education:  High School Diploma or equivalent required

Experience:

• Preference for minimum of one-year experience working closely with healthcare claims or in a claims processing/adjudication environment
• Open to training candidates without experience

Technical Skills / Knowledge:

• Understanding of health claims processing/adjudication
• Ability to perform basic to intermediate mathematical computation routines
• Medical terminology strongly preferred
• Understanding of ICD-9 & ICD-10
• Basic MS office computer skills
• Ability to work independently or within a team
• Time management skills
• Written and verbal communication skills
• Attention to detail
• Must be able to demonstrate sound decision-making skills

Salary: $15.00 - $18.00 per hour based on experience.

Job Type: Full-time

Benefits:

• Dental insurance
• Health insurance
• Vision insurance
• Performance Bonus
• Referral Bonus
• PTO

 Schedule:

• 8 hour shift
• Monday to Friday
• Flexible schedule

Work Location: Hybrid remote in Tampa, FL 33618

 Ability to commute/relocate:

• Tampa, FL 33618: Reliably commute or planning to relocate before starting work (Required)