• Medical Claims Processor Lead

    Job Locations US-TX-Waco
    Posted Date 1 month ago(12/19/2018 5:09 PM)
    Job ID
  • Overview

    ProSphere is seeking a Medical Claims Processor Lead with strong customer service skills and experience working in a team environment. The qualified candidate will possess subject matter knowledge in medical claims processing. This is a full-time position. Veterans are encouraged to apply.


    • 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.
    • Assist in a variety of administrative matters.
    • Maintain a wide variety of medical or other records.
    • Verify medical claims and vouchers for accuracy and completeness in accordance with VA policy, Medicare regulations, and medical claims coding regulations and guidelines.
    • Resolve medical claim inquiries and/or complaints via phone and online.
    • Provide leadership and guidance to junior level staff.
    • Train personnel on VA-FSC systems, if needed.


    • High School Diploma or equivalent
    • 3+ 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
    • Ability to work overtime required on occasion 
    • Ability to sit in an office environment for long periods of time 




    ProSphere offers full-time employees a comprehensive and competitive benefits package including paid vacation, sick leave, holidays, health insurance, life insurance, military leave, training, tuition reimbursement, a wellness program, short- and long-term disability, 401(k) retirement plan with company matches/immediate vesting, commuter benefits, and more.


    It is ProSphere’s policy to promote equal employment opportunities. All personnel decisions, including, but not limited to, recruiting, hiring, training, promotion, compensation, benefits and termination, are made without regard to race, creed, color, religion, national origin, sex, age, marital status, sexual orientation, gender identity, citizenship status, veteran status, disability or any other characteristic protected by applicable federal, state or local law.


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