What are the responsibilities and job description for the Healthcare Claims Processor II position at KARNA LLC?
Description :
Join the Karna Team as a Temporary, Full-Time Medical Claims Processor. Become an integral part of a team dedicated to servicing the World Trade Center Health Program. In this role, you will leverage your meticulous attention to detail and commitment to accuracy in processing complex medical claims. If you're eager to make a positive impact in our community through your administrative skills, we encourage you to apply!
Job Responsibilities :
- Claims Review and Processing : Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.
- Critical Analysis : Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios.
- Timely Processing : Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers.
- Issue Resolution : Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions.
- Confidentiality Maintenance : Uphold the confidentiality of patient records and company information as per HIPAA regulations.
- Detailed Record Keeping : Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability.
- Trend Monitoring : Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting.
- Audit Participation : Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes.
- Mentoring : Mentors and trains new claims processors as needed.
Requirements :
PM18
PIfe73d5822e18-25406-36316759