Medical Claims Processing SME/EDI/CoE

TISTA Science and Technology is seeking to hire a Medical Claims Processing SME/EDI/CoE to join our growing team in Austin!

TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Tuition Reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more!

Performs research on claim problems by utilizing approved policies, procedures, reference training materials, forms and coordinates with various internal support areas
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims
• Ensures claims are processed according to established quality and production standards
• Assists the lead medical claims processor in training or mentoring new staff members
• Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints
• Use extensive knowledge and judgement to independently complete assignments consisting of numerous steps that vary in nature and sequence.
• Select from alternative methods and refer problems not solvable by adapting or interpreting substantive guides, manuals, or procedures.
• Verify medical claims and vouchers for accuracy and completeness in accordance with VA policy, Medicare regulations, and medical claims coding regulations and guidelines.
• Provide leadership and guidance to junior level staff.
• Train personnel on VA-FSC systems, if needed.

• 5+ years of experience processing medical claims and vouchers
• Possess thorough understanding of CPT, HCPCS, ICD-10-CM, and ICD-10-CM standards
• Working knowledge of MS Office, Access, and Excel
• Demonstrated success working in a team environment
• Knowledge of billing and follow-up regulations relating to Medicare
• Strong customer service skills
• In depth understanding of electronic claims editing and submission capabilities, including Medicare and NEIC online processing and query system

Education:

• Bachelor's Degree in related field of study

Clearance:

• Ability to obtain Moderate Background Investigation (MBI) clearance

Location:

• Remote, USA

Pay Range:

• The pay for this position ranges from $79,240 to $92,500
• The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location.
• Also, certain positions are eligible for additional forms of compensation, such as bonuses.
• TISTA associates are eligible to participate in our comprehensive benefits plan! More information can be found here: https://tistatech.com/working-at-tista/