Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-10 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
New
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-10 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
New
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-10 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-10 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-10 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
New
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-10 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
New
Claims Examiner I
San Antonio, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
Claims Examiner I
San Antonio, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
New
Claims Examiner I
Irving, TX · On-site
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
New
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
... edit logic). * Incumbents are expected to meet and/or exceed qualitative and quantitative ... Knowledge of CPT and ICD-9 coding required. * Knowledge of COBRA, HIPAA, pre-existing conditions ...
Claims Clerk
Dallas, TX · On-site
$16 - $25/hr
... ability to create, edit, save and send documents, spreadsheets and correspondence * Basic ... Basic understanding of healthcare claims including ICD-10 and CPT codes Telecommuting Requirements:
Claims Clerk
Dallas, TX · On-site
$16 - $25/hr
... ability to create, edit, save and send documents, spreadsheets and correspondence * Basic ... Basic understanding of healthcare claims including ICD-10 and CPT codes Telecommuting Requirements:
... to edit claim data and other assistance with follow up and/or appeal actions. * Reviews procedure and diagnosis codes to make sure they conform to third party rules and ensure appropriate ...
... to edit claim data and other assistance with follow up and/or appeal actions. * Reviews procedure and diagnosis codes to make sure they conform to third party rules and ensure appropriate ...
... to edit claim data and other assistance with follow up and/or appeal actions. * Reviews procedure and diagnosis codes to make sure they conform to third party rules and ensure appropriate ...
... to edit claim data and other assistance with follow up and/or appeal actions. * Reviews procedure and diagnosis codes to make sure they conform to third party rules and ensure appropriate ...
... Facets, and related adjudication and edit engines (e.g., ClaimsXten, Cotiviti, EDIFECS ... Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Claims ...
... Facets, and related adjudication and edit engines (e.g., ClaimsXten, Cotiviti, EDIFECS ... Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Claims ...
Certified Professional Coder-Hospital (CPC-H) * Certified Professional Coder (CPC) Skills or ... claims from billing, by reviewing claims information, medical records and other applicable ...
Certified Professional Coder-Hospital (CPC-H) * Certified Professional Coder (CPC) Skills or ... claims from billing, by reviewing claims information, medical records and other applicable ...
Under the supervision of the Revenue Cycle Supervisor, responsible for revenue cycle functions including and not limited to coding/edit charge review, accurate timely submission of insurance claims ...
Under the supervision of the Revenue Cycle Supervisor, responsible for revenue cycle functions including and not limited to coding/edit charge review, accurate timely submission of insurance claims ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Under the supervision of the Revenue Cycle Supervisor, responsible for revenue cycle functions including and not limited to coding/edit charge review, accurate timely submission of insurance claims ...
Under the supervision of the Revenue Cycle Supervisor, responsible for revenue cycle functions including and not limited to coding/edit charge review, accurate timely submission of insurance claims ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Process accurate code assignments for paper and /or electronic claims and required billing data elements prior to charges being processed for payment and revenue reporting, including coding /edit ...
Claims Edit Coder information
What are the key skills and qualifications needed to thrive as a Claims Edit Coder, and why are they important?
To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.
What are Claims Edit Coders?
Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.
What is the difference between Claims Edit Coder vs Claims Processing Specialist?
| Aspect | Claims Edit Coder | Claims Processing Specialist |
|---|---|---|
| Certifications | Certified Coding Associate (CCA), CPC | None required, but certifications can be beneficial |
| Work Environment | Healthcare facilities, insurance companies, remote | Insurance companies, healthcare providers, office setting |
| Primary Responsibilities | Review and correct claim data, ensure coding accuracy | Process claims from submission to payment, handle inquiries |
Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.
What are some common challenges faced by a Claims Edit Coder, and how can they be addressed?
Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.
What are popular job titles related to Claims Edit Coder jobs in Texas? For Claims Edit Coder jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Claims Edit Coder jobs in Texas look for? The top searched job categories for Claims Edit Coder jobs in Texas are:
What cities in Texas are hiring for Claims Edit Coder jobs? Cities in Texas with the most Claims Edit Coder job openings:
WebTPA rating
7.5
Based on 6 frontline employees who took The Breakroom Quiz
198th of 277 rated insurance
Job description
Get To Know Us!
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.
Key position details:
- Training Schedule: Monday to Friday 8:00am to 4:30pm Central Time
- Training Duration: 4 weeks
- Training Classes Starting: 7/20/2026
- Full Time position
What is your impact?
As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity.
What Will You Be Doing:
- Day-to-day processing of claims for accounts:
- Responsible for processing of claims (medical, dental, vision, and mental health claims)
- Claims processing and adjudication.
- Claims research where applicable.
- Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
- Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
- Investigation and overpayment administration:
- Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
- Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
- Utilize systems to track complaints and resolutions.
- Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading.
What You Must Have:
- 2+ years related work experience.
- Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
- High school diploma or GED
- Knowledge of CPT and ICD-10 coding required.
- Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required.
- Must possess proven judgment, decision-making skills and the ability to analyze.
- Ability to learn quickly and multitask.
- Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers.
- Concise written and verbal communication skills required, including the ability to handle conflict.
- Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding.
- Review of multiple surgical procedures and establishment of reasonable and customary fees.
What We Prefer:
- Some college courses in related fields are a plus.
- Other experience in processing all types of medical claims helpful.
- Data entry and 10-key by touch/sight
General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.
About WebTPA
Sourced by ZipRecruiter
Industry
Insurance services
Company size
501 - 1,000 Employees
Headquarters location
Irving, TX, US
Year founded
1993