The Claims Examiner I adjudicates incoming claims in accordance with policies, procedures and guidelines, as outlined by Leon Health and contractual agreements; within mandated timeframes; and according to rates as reflected in respective provider contracts. The Claims Examiner I will be responsible for adjudicating claims from a variety of medical specialties in a timely manner to maintain turnaround time regulatory requirements. Summary of Essential Duties and Responsibilities ? Enter claim data accurately and timely, in alignment with departmental production and quality goals ? Manually price and adjudicate claims as needed. ? Maintain a minimum of 98% accuracy at all times ? Apply policies and procedures to confirm that claims meet criteria for payment and are in compliance with MBA contractual guidelines ? determination. ? Ensure claims payments are made within time frames as reflected in contractual agreements ? Identify and refer potential fraud and abuse cases to the Compliance Department ? Other duties and responsibilities as may be assigned. Minimum Requirements ? High School diploma or GED equivalent ? Minimum of two years? experience in healthcare claims processing, medical billing or an equivalent combination of education, training and experience ? Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel. ? Detailed knowledge of electronic billing processes and universal billing forms (UB04, CMS-1500) ? Strong knowledge of medical terminology ? Knowledge of CPT Codes and HCPCs codes ? Knowledge of ICD-10 coding ? HIPAA regulations ? Medicaid and Medicare claim processing experience a plus ? Ability to read and interpret general business correspondence, procedure manual, and specific plan document Abilities Required ? Ability to manage multiple tasks and prioritize work to adhere to deadlines and identified time frames ? Ability to read, write and communicate at a professional level ? Effective time management and organizational skills ? Effective interpersonal and communication skills