RIT Solutions, Inc.
Title:
Claims Examiner Location:
Remote (Candidate must reside in California - no exceptions) Duration:
6+ month contract
Position Summary: The Claims Examiner is responsible for providing comprehensive claims support by reviewing, analyzing, and researching complex healthcare claims. This role involves identifying discrepancies, verifying pricing, confirming prior authorizations, and ensuring accurate claims processing and payment. Required Experience and Qualifications: • Minimum of 3 years' experience working with QNXT version 5.9 or higher • Certified Medical Coder certification is a plus • Experience processing Medi-Cal claims nd understanding regulatory requirements • Excellent verbal and written communication skills • Familiarity with NetworX Pricer for claims pricing and reimbursement is a plus • Proficient in adjudicating claims using QNXT, including resolving pended or denied claims • Strong understanding of claims adjudication processes, benefit structures, and provider contracts • In-depth knowledge of the entire claims lifecycle, including submission, processing, adjudication, and payment • bility to ensure correct application of benefit plans, provider contracts, pricing schedules, and service agreements during claims adjudication • Skilled in analyzing claims for accurate use of CPT, ICD, HCPCS , and revenue codes against billed charges • Capable of manually adjusting pended or escalated claims to resolve complex issues such as provider disputes, coordination of benefits (COB), and payment errors
Claims Examiner Location:
Remote (Candidate must reside in California - no exceptions) Duration:
6+ month contract
Position Summary: The Claims Examiner is responsible for providing comprehensive claims support by reviewing, analyzing, and researching complex healthcare claims. This role involves identifying discrepancies, verifying pricing, confirming prior authorizations, and ensuring accurate claims processing and payment. Required Experience and Qualifications: • Minimum of 3 years' experience working with QNXT version 5.9 or higher • Certified Medical Coder certification is a plus • Experience processing Medi-Cal claims nd understanding regulatory requirements • Excellent verbal and written communication skills • Familiarity with NetworX Pricer for claims pricing and reimbursement is a plus • Proficient in adjudicating claims using QNXT, including resolving pended or denied claims • Strong understanding of claims adjudication processes, benefit structures, and provider contracts • In-depth knowledge of the entire claims lifecycle, including submission, processing, adjudication, and payment • bility to ensure correct application of benefit plans, provider contracts, pricing schedules, and service agreements during claims adjudication • Skilled in analyzing claims for accurate use of CPT, ICD, HCPCS , and revenue codes against billed charges • Capable of manually adjusting pended or escalated claims to resolve complex issues such as provider disputes, coordination of benefits (COB), and payment errors