Job description

Job Summary

Imagenet LLC is a premier healthcare technology company that has taken medical claims processing and document management to new levels of service, security and efficiency. Our core business is helping our clients reduce costs and increase productivity by providing efficient document imaging, data validation, adjudication and on demand retrieval of documents and data.

Must be in the Forty Fort, PA area. This position cannot be performed out of state.

JOB OVERVIEW

Must have Leadership/Management experience

Ensure compliance with all corporate and departmental standards. Meet with employees on a regular basis to discuss performance and quality. Report on Key Performance Metrics (KPIs) to the Vice President of Claims Operations to ensure adequate resources and technology are in place. Develop and implement departmental standards and expectations. Analyze and process a variety of claim files to ensure the execution of standardized claim protocol and claim handling.

RESPONSIBILITIES

· Oversee the claims adjudication process to assure that the examiners are following all CMS rules and regulations in conjunction with the insurance company guidelines

· Must have an innate ability to oversee staff and coach, support and have the ability to conduct conversations relative to performance, work ethic and anything other issues relative to the employee’s responsibilities

· Ensure that the department practices meet or exceed the client’s processing standards, procedures and service level agreements

· Responsible for new Claims Analyst training and auditing of trainee claim processing

· Authorize claim payments within established limits; otherwise forward to Claims Analyst 2

· Process refunds and letters of dual coverage (when applicable);

· Must be knowledgeable in CPT-4, ICD-9 and be familiar with medical terminology;

· Identify process improvement opportunities within the claim department and recommend system enhancements

· Handles any additional responsibility which may be assigned

Technical Skills/Knowledge

· Health claims processing

· Basic to intermediate math

· Medical terminology; ICD-9 & ICD-10

· MS Office

· Ability to work independently or within a team

· Time management

· Written and verbal communication

· Attention to detail

· Must be able to demonstrate sound decision-making

· Must be local to Forty Fort, PA area and work out of the local office. Some remote may be offered after training.

Job Type: Full-time

Pay: $22.00 - $26.00 per hour

Benefits:

• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Kingston, PA 18704: Reliably commute or planning to relocate before starting work (Required)

Experience:

• medical claims: 1 year (Required)
• Health claims processing: 1 year (Required)
• Leadership: 1 year (Required)

Work Location: Hybrid remote in Kingston, PA 18704

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