• Homestead, FL, United States
Medgroup Homestead, FL, USA
Job Description Job Summary The Billing & Coding Specialist adjudicates incoming claims in accordance with policies, procedures and guidelines; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements. Summary of Essential Duties and Responsibilities * Enter claim data accurately and timely, in alignment with departmental production and quality goals * Manually price and adjudicate claims as needed. * Maintain a minimum of 98% accuracy at all times * Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines * determination. * Ensure claims payments are made within time frames as reflected in contractual agreements * Identify and refer potential fraud and abuse cases to the Compliance...