Adjustment Examiner 2

<strong>At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We&rsquo;re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.</strong>

Cheyenne, WY

CNSI

<strong>CNSI delivers a broad range of health information technology enterprise solutions and customizable products to a diverse base of state and federal agencies. We align, build, and manage innovative, high-quality, cost-effective solutions that help customers achieve their mission, enhance business performance, reduce costs, and improve health for over 51 million Americans.</strong> https://www.cns-inc.com/

keywords: summary,quality assurance,analysis,research,medical,organization,solutions,values,education,technology,management,compensation

Full-Time

Overview: The Adjustment Examiner 2 is responsible for working and dispositioning claim adjustments in accordance with operational adjustment procedures. This role will also serve medical insurance customers by determining insurance coverage, examining and resolving medical claims, documenting actions, maintaining quality customer services, and ensuring legal compliance. <br />This position is in Cheyenne, Wyoming.
Responsibilities: <ul> <li>Examine scanned paper claims and attachments by batching and reconciliation/balancing of all paper claim submissions, and balance from receipt of claim to adjudication finalization.</li> <li>Research attachments to claims and maintain images within the claim&rsquo;s workflow process and associated with the claims presented for adjudication.</li> <li>Independently research and resolve medical claims data, making necessary corrections of information by comparing data with source documents to identify root causes.</li> <li>Determine additional information needed to complete adjudication of claims.</li> <li>Independently research and review submitted claims (paper or electronic) requesting adjustment consideration, and process according to operational policies and procedures, as well as make the appropriate claim adjustment into the claims system according to contractual requirements and timelines.</li> <li>Independently resolve medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.</li> <li>Independently ensure legal compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.</li> <li>Maintain quality customer services by following customer service practices; responding to customer inquiries.</li> <li>Protect operations by keeping claims information confidential; prepare reports by collecting, analyzing and summarizing information.</li> <li>Update job knowledge by participating in educational opportunities; reading professional publications.</li> <li>Accomplish organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.</li> </ul>
Requirements: <ul> <li>You are a High School graduate or equivalent and two (2) to five (5) years as a Claims Assistant or similar role.</li> <li>You will be available to work from 7:00 AM to 6:00 PM Mountain Time on all State business days, Monday through Friday (excluding Wyoming State holidays).</li> <li>You have a general knowledge of claims and medical terminology and are familiar with medical bill/claim forms, claim forms.</li> <li>You have expert knowledge of medical and dental terminology including medical diagnosis and procedure codes, and claims pricing methodologies such as DRG, manual pricing, and fee for service experience.</li> <li>You can solve problems and properly calculate benefits using mathematics; identify appropriate solutions using logic and reasoning.</li> <li>You can gather facts using verbal, non-verbal (active listening), and other human relations skills.</li> <li>You can manage multiple simultaneous projects; working independently in a multi-tasking office setting.</li> <li>You are proficient with Microsoft Office and will be able to learn and implement specialty software systems and procedures.</li> <li>You can read and comprehend information, communicating information and ideas clearly, both verbally and in writing, so others, including physicians, will understand.</li> <li>You can compute basic mathematical equations including addition, subtraction, percentages, and fractions.</li> <li>You have the initiative to obtain clarification for any task or situation that may be unclear.</li> <li>You can make sound decisions utilizing good judgment and reasoning; can work well in a team environment; establish and maintain effective working relationships with others.</li> </ul> <br /> <p><strong><em>About Us:</em></strong></p> <p>At CNSI, we strive to be the market leader and most trusted partner for innovative and transformative technology-enabled solutions that improve health outcomes and reduce costs. We&rsquo;re passionate about helping our clients improve the health and well-being of individuals and families. We succeed when our clients succeed.</p> <p>Innovation and commitment to our mission are core to our DNA. And through our shared values, we foster an environment of inclusion, empowerment, accountability, and fun! You will be offered a competitive compensation and benefits package.</p> <p>CNSI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, marital status, genetic status, family responsibilities, protected veteran status, or any other status protected by applicable Federal, State, or Local Law. We are proud of our diversity and encourage all qualified applicants to apply.<strong>&nbsp;</strong></p>