HealthCare (Medical) Claims Auditors and Examiners – REMOTE

JMS and Associates, a Smart Data Solutions Company, is looking to the future.  As a technology leader in healthcare process automation and interoperability, Smart Data Solutions (SDS), is a strategic partner that utilizes data and intelligent automation to digitally transform operations and deliver outcomes for clients which reduces costs, streamline workflows, and improves overall customer experience.  Smart Data Solutions has ambitious growth plans for the next few years and is currently seeking a Healthcare Claims Auditor and/or Examiner to join our growing team.

What we’re looking for?

JMS and Associates, a Smart Data Solutions Company, is seeking individuals with medical claim adjudication and/or auditing experience.  If you are proficient interpreting Summary Plan Documents and possess the ability to process claims in a fast and accurate manner – this position is for you!

Qualified candidates possess:

• Minimum: High School Diploma or equivalent
• Experience using current computer equipment and applications such as laptops and Microsoft Office Suite
• Proficiency with Ten Key and Typing skills (minimum 44 wpm accuracy 97% and 6k kph with 97% accuracy)
• Intermediate-level experience with MS Excel
• Basic anatomy and medical terminology knowledge
• 3 years of experience reviewing and interpreting data on medical claim forms.
• Familiarity with medical claim forms HCFA, CMS1500, UB04, and ADA
• Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT, and Modifiers

Preferred candidates possess:

• Certified Coding credentials (AHIP or AAPC)
• Practical Claim Processing and/or Auditing experience on the Eldorado HealthPac platform
• Organizational skills and experience prioritizing project work and tasks
• Experience in the health care industry such as medical insurance or TPA, medical billing, coding, or doctor’s office
• Experience with Claim Adjudication platforms such as LuminX, Javelina, Eldorado and WLT

Why this is the company for you?

Top Benefits & Perks:

• Generous benefits include health insurance, short-term, and long-term disability
• Professional development and growth-oriented workplace
• 401(k) with a company match to provide a better future in your retirement years
• Work-life balance with competitive paid time off package; including vacation, holidays, and a floating day

Who is Smart Data Solutions?

Smart Data Solutions is a technology vendor that brings 22 years of healthcare experience using intelligence and automation to extract data from front-office mailroom operations. Today, the company is expanding out from its front office focus and targeting its open-source automation and AI engines toward the entire healthcare operations value chain.  One of the key benefits of working with Smart Data Solutions is their specialized approach to data capture and automation. Smart Data Solutions takes a comprehensive approach to image and document processing, using multiple engines and hundreds of thousands of lines of code to ensure accuracy and make sense of data. Smart Data Solutions has also invested heavily in EDI interoperability, with clearinghouse capabilities that enable them to pivot towards providing value-added services. Using the data they have collected, they are able to offer population health insights to clients, helping them make informed decisions about their largest areas of spending and identifying potential opportunities for cost savings.

Smart Data Solutions’ global headquarters are just outside of St. Paul, MN with 400+ employees and leverages dedicated onshore and offshore resources as part of its service delivery model. The company counts over 500 healthcare organizations as clients, including multiple Blue Cross Blue Shield state plans, regional health plans, and TPAs, handling over 2 billion transactions of varying types annually with a 98%+ customer retention rate. SDS plans to continue investments into meaningfully in automation and machine learning capabilities across its tech-enabled processes to drive scalability and greater internal operating efficiency while also improving client results.

SDS has partnered with a leading growth-oriented investment firm, Parthenon Capital Partners, and the Blue Venture Fund, a unique collaboration among Blue Cross Blue Shield (BCBS) companies, to further accelerate expansion and product innovation.

Smart Data Solutions acquired JMS and Associates in Q3 of 2022. The combination of both SDS’ and JMS’ tech-enabled solutions will bring greater operational efficiency through automation to various markets across the healthcare industry. We are able to provide a greater product suite, allowing us to broaden the scope of our solutions to solve more business challenges for our clients and across the industry.

Location:

Smart Data Solutions is located in Eagan, MN.

JMS and Associates, A Smart Data Solutions Company, is located in Farmington Hills, MI.

This position is a remote position.

Smart Data Solutions is an equal-opportunity employer.

All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or another legally protected status.