Tista Science and Technology Corporation

Welcome page

Medical Claims Processing SME/EDI/CoE

Job ID 2024-5471
Job Locations US-Remote-United States

Overview

TISTA Science and Technology is seeking to hire a Medical Claims Processing SME/EDI/CoE to join our growing team in Austin!

 

TISTA associates enjoy above Industry Healthcare Benefits, Remote Working Options, Paid Time Off, Training/Certification opportunities, Healthcare Savings Account & Flexible Savings Account, Paid Life Insurance, Short-term & Long-term Disability, 401K Match, Tuition Reimbursement, Employee Assistance Program, Paid Holidays, Military Leave, and much more!

 

Responsibilities

  • Performs research on claim problems by utilizing approved policies, procedures, reference training materials, forms and coordinates with various internal support areas
  • Corrects processing errors by reprocessing, adjusting, and/or recouping claims
  • Ensures claims are processed according to established quality and production standards
  • Assists the lead medical claims processor in training or mentoring new staff members
  • Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints
  • 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.
  • Verify medical claims and vouchers for accuracy and completeness in accordance with VA policy, Medicare regulations, and medical claims coding regulations and guidelines.
  • Provide leadership and guidance to junior level staff.
  • Train personnel on VA-FSC systems, if needed.

Qualifications

  • 5+ 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 

 

Education:

  •  Bachelor’s Degree in related field of study

 

Clearance:

  • Ability to obtain Moderate Background Investigation (MBI) clearance

Location: 

  •  Remote, USA
 

 

Pay Range:

  • The pay for this position ranges from $79,240 to $92,500
  • The actual salary offer will carefully consider a wide range of factors, including your skills, qualifications, experience, and location.
  • Also, certain positions are eligible for additional forms of compensation, such as bonuses.
  • TISTA associates are eligible to participate in our comprehensive benefits plan! More information can be found here: https://tistatech.com/working-at-tista/

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed


TISTA Science and Technology Corporation, a CMMI Maturity Level 3 company, focuses on delivering information technology and professional services to Federal and State agencies. TISTA is recognized in 2019 by Inc. 5000 as one of the fastest-growing private companies in the US. TISTA is also a recipient of 2019 Top Veteran-Owned Companies by the Washington Business Journal. TISTA also received a 2018 Moxie Award in the GovCon category.

Here at TISTA Science and Technology, we value Veterans and encourage all to apply!
#thinktista #tistacares #tistavaluesvets

Employment Transparency:
TISTA is an Equal Opportunity/Affirmative Action Employer and embraces diversity in our employee population. It is the policy of TISTA to provide equal opportunity to all qualified applicants and employees without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or genetic information. TISTA will refrain from discharging, or otherwise discriminating against, employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants.

The EEO is the Law poster is available here, and the poster supplement is available here.
The Pay Transparency Policy is available here.

Tista is committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation due to a disability for any part of the employment process, please send an e-mail to recruiting@tistatech.com or call (301) 968-3420 and let us know the nature of your request and your contact information.

TISTA is a federal contractor and is subject to the federal contractor COVID requirements under the new FAR/DFARS clauses and must comply with the incorporated Guidance.

If the candidate is hired to perform work on or in connection with one of TISTA’s federal contracts, TISTA is contractually obligated to ask the candidate to verify and show proof of vaccination status and the candidate will be required to comply with mask and social distancing requirements imposed by the FAR/DFARS as well as any additional requirements imposed by TISTA’s customers for any required onsite work.