Claims Processor (with Facets) - Healthcare Remote

We strive to provide flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified applicants in the United States. Regardless of your working arrangement, we are here to support a healthy work-life balance though our various wellbeing programs. Location: Remote (Work-from-Home) Schedule: Monday to Friday 8am - 4:30pm ET Experience: A minimum of 2 years of claim processing is required. Travel: None required About the role: As Claims Adjudication Specialist, you will be responsible for timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments. You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams. In this role, you will: • Be Responsible for reviewing the data in the claim processing system and comparing with corresponding UB or HCFA paper or EDI information. • Responsible for reviewing medical records when necessary to determine if service rendered was medically appropriate and criteria have been met. • Responsible for reviewing claim and line-item edits and warning messages for determination of whether to pay claim/line item(s). • Ensuring all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs. • Assigning special projects or other duties as determined by management. What you need to have to be considered: • A minimum of 2 years claim processing is required. • Knowledge of physician practice and hospital coding, and medical terminology, CPT, HCPCS, ICD-10 • Experience making payments with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims • Knowledge of Medicare/ Medicaid payment and coverage guidelines and regulations. • 1 year of Facets experience. • Experience in the analysis and processing of claims for payments, utilization review/quality assurance procedures. • Must be able to work with minimal supervision. • Good skills at problem resolution specifically related to healthcare claim adjudication. • Possess ability to work at a computer for extended periods. • Can work closely with other departments Required Education and Experience · High School degree or GED or equivalent experience.

Cognizant is one of the world's leading professional services companies, transforming clients' business, operating, and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build, and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant (a member of the NASDAQ-100 and one of Forbes World's Best Employers 2024) is consistently listed among the most admired companies in the world.