In this Role the candidate will be responsible for: Processing of Professional claim forms files by provider Reviewing the policies and benefits Comply with company regulations regarding HIPAA, confidentiality, and PHI Abide with the timelines to complete compliance training of NTT Data/Client Work independently to research, review and act on the claims Prioritize work and adjudicate claims as per turnaround time/SLAs Ensure claims are adjudicated as per clients defined workflows, guidelines Sustaining and meeting the client productivity/quality targets to avoid penalties Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA. Timely response and resolution of claims received via emails as priority work Correctly calculate claims payable amount using applicable methodology/ fee schedule
Requirements: 1-3 year(s) hands-on experience in Healthcare Claims Processing 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools High school diploma or GED. Previously performing – in P&Q work environment; work from queue; remotely Key board skills and computer familiarity – Toggling back and forth between screens/can you navigate multiple systems. Working knowledge of MS office products – Outlook, MS Word and MS-Excel. Must be able to work 7am - 4 pm CST online/remote