Melville, New York, United States · On-site
Key Responsibilities Apply medical policy, contractual provisions, and operational procedures to ensure accurate Medical claims. Resolve claim holds, review history records, and determine benefit eligibility for services…
Skills: Medical Claims Processing, Medical Terminology, CPT/HCPCS Coding, ICD Coding, Benefits Administration
Las Vegas, Nevada, United States · On-site
Primary Responsibilities Review and adjudicate claims submitted for reimbursement that fall outside auto adjudication standards on a daily basis, ensuring compliance with quality, productivity, and timeliness requirement…
Skills: Claims Adjudication, Medical Billing, Medical Terminology, Healthcare Contracts, Analytical Skills
Las Vegas, Nevada, United States · On-site
Primary Responsibilities Review and adjudicate claims submitted for reimbursement that fall outside auto adjudication standards on a daily basis, ensuring compliance with quality, productivity, and timeliness requirement…
Skills: Claims Adjudication, Medical Billing, Medical Terminology, Healthcare Contracts, Analytical Skills
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The role involves adjudicating medical claims by applying policies and contractual provisions to ensure accuracy and eligibility. It also requires resolving claim holds and communicating with internal teams and customers to resolve issues.
Candidates must have a High School Diploma or GED and 1 to 3 years of experience in medical or hospital claims processing. Proficiency in medical coding (CPT/HCPCS, ICD) and claims processing systems is required.
The Nationwide TPA trusted for over 30 years
MagnaCare, a division of Brighton Health Plan Solutions, has been a leading and trusted Third Party Administrator for over 30 years. MagnaCare’s wide range of products and services meet the needs of Taft-Hartley Funds, employers, brokers, and other self-insured plan sponsors, TPAs, carriers, and workers’ compensation and no-fault payors. Through our deep discounts, innovative health care solutions, and uncommon flexibility, we help our customers control health care costs, improve health, and achieve exceptional value for their organizations and their members.
Offices: One Penn Plaza, 53rd Floor, NY, New York 10119, US · 1600 Stewart Avenue, Seventh Floor, Westbury, NY 11590, US · 2 Huntington Quadrangle, Suite 4N10, Melville, NY 11747, US · 44 West Gilbert Street, Tinton Falls, NJ 07701, US
The Nationwide TPA trusted for over 30 years
MagnaCare, a division of Brighton Health Plan Solutions, has been a leading and trusted Third Party Administrator for over 30 years. MagnaCare’s wide range of products and services meet the needs of Taft-Hartley Funds, employers, brokers, and other self-insured plan sponsors, TPAs, carriers, and workers’ compensation and no-fault payors. Through our deep discounts, innovative health care solutions, and uncommon flexibility, we help our customers control health care costs, improve health, and achieve exceptional value for their organizations and their members.
Offices: One Penn Plaza, 53rd Floor, NY, New York 10119, US · 1600 Stewart Avenue, Seventh Floor, Westbury, NY 11590, US · 2 Huntington Quadrangle, Suite 4N10, Melville, NY 11747, US · 44 West Gilbert Street, Tinton Falls, NJ 07701, US
