Local third-party insurance office looking to hire claims processor in the Houma area!

Duties Include :

Provide timely processing of medical claims. This includes approving, pending and denying claims according to the accepted coverage guidelines.

Request and review correspondence such as medical records in order to make a claim payment determination.

Correspond with medical providers, plan members, and clients.

Maintain working relationship with nurse case managers.

Maintain patient confidentiality in accordance with HIPAA and company policies.

Coordinate benefits with other medical insurance plans, Medicaid and Medicare.

Education, Knowledge, Experience :

• Knowledge and use of CPT and ICD-10 coding
• Knowledge of medical insurance including plan deductible, co-insurance, out-of-pocket, PPO Networks, etc.
• Knowledge of HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification, provider verification and preauthorization desirable.
• Third Party Administrator knowledge and experience a plus.
• Experience in many facets of the managed healthcare insurance business.

Essential Skills :

• Strong interpersonal skills and a customer service focus with high standards of quality
• High degree of self-discipline and motivation
• Able to work independently with minimal supervision and as part of a team
• Strong written and verbal communication skills; professional presentation

Last updated : 2024-06-13