Responsible for the adjudication of medical claims at all pend levels in an accurate and timely manner as required by corporate and departmental standards on accuracy and production.
Responsible for the resolution of pended claims in an accurate and timely manner according to departmental processes, procedures and guidelines and in compliance with departmental and corporate standards for accuracy, quality and production.
Responsible for resolution of system Batch Errors.
Responsible for initiating inquiries to other parties as needed to address pended claims issues or resolving inquiries associated with claims adjudication.
Perform other reasonably related duties, including special projects as assigned by immediate supervisor and other management staff as required.
QUALIFICATIONS
High School Diploma or GED required. Associate's or Bachelor's degree in Health Care or related field preferred.
One year of claims processing/claims resolution experience on an automated claims processing system to have included strong knowledge and use of CPT/ICD codes and standard health claim billing forms. OR
Two years of claims related experience or provider billing/coding experience, which included significant use and application of CPT/ICD codes and standard health industry claim billing forms or 3 years' experience in any Claims or Customer Service position within the organization. Must be able to demonstrate knowledge of medical terminology, coding, billing, and claims processing obtained through work experience and/or completion of relevant claims or billing coursework. OR
Associate's or Bachelor's degree in healthcare claims or billing which included significant coursework and demonstrated knowledge of CPT and ICD coding, standard billing forms and medical terminology may be accepted in lieu of actual claims processing experience.
Ability to create or modify existing Microsoft Office Suite software (e.g. Word, PowerPoint, Excel, and Access) documents and reports required.
Effective verbal and written communication.
Reading comprehension skills with the ability to interpret complex procedures.
Successful experience working in a team environment.
Analytical problem-solving skills.
Proficient in data entry.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
