Responsible for the accurate processing and completion of medical claims based defined claims guidelines and policies. Associate can demonstrate proficiency in product lines applicable to the processing unit.

Process new claims or modifies existing claims according to the appropriate and applicable action

Analyze claims to determine appropriate action to approve or deny a claim for payment

Determine accurate payment criteria for clearing pending claims based on defined policies and procedures

Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims

Review and address provider inquiries regarding claim adjudication

Demonstrate ability to work on high volume of repetitive claims

Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards

Work Experience

At least 2 years experience in medical claims

Experience with medical coding to include diagnosis coding and terminology is an advantage but not required

Skillset

Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols is a must

Ability to multi-task and follow documented claims processes with minimal supervision

Excellent verbal and written business communication skills required

Strong proficiency in Windows OS and Microsoft Office applications, particularly Excel

Strong attention to detail and the ability to make appropriate decisions based on information presented