What are the responsibilities and job description for the Adjustment Examiner I position at Capital Blue Cross?
Position Description
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The position processes claim adjustments within established timeframes. Process adjustments in the FACETS system utilizing established policies and procedures to review and correct error and warning messages. Utilize various tools within the FACETS system and other CBC systems to research claims to ensure proper adjudication. Partner with other CBC departments and CBC vendor partners as needed to complete claim adjudication. Communicate with providers as needed to obtain information needed to process. Must perform all duties in compliance with HIPAA regulations.
Responsibilities And Qualifications
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.
And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.
Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”
The position processes claim adjustments within established timeframes. Process adjustments in the FACETS system utilizing established policies and procedures to review and correct error and warning messages. Utilize various tools within the FACETS system and other CBC systems to research claims to ensure proper adjudication. Partner with other CBC departments and CBC vendor partners as needed to complete claim adjudication. Communicate with providers as needed to obtain information needed to process. Must perform all duties in compliance with HIPAA regulations.
Responsibilities And Qualifications
- Adjudicate claim adjustments in FACETS by researching and resolving error and warning messages within established timeframes.
- Utilize various tools within the FACETS system and other CBC systems to research claims to ensure proper adjudication
- Partner with other CBC departments and CBC vendor partners as needed to complete claim adjudication.
- Review and take necessary action as needed in response to inquiries from internal business partners, through Facets inquiries, e-mail, and imaged paper correspondence.
- Perform outreach (both verbal and written) to providers as needed to obtain additional information to process adjustments.
- All other duties and assignments as directed.
- Knowledge and familiarity with claims processing, FACETS, Work Desk, and HIPAA policies and regulations preferred
- Familiarity with Provider and Subscriber billing documents and applicable billing terminology preferred
- Ability to operate a personal computer (PC) and other office equipment (e.g., copy machine, fax machine, printer, calculator, and etc.) as well as possess excellent keyboarding skills
- Demonstrated competency in the use of computer applications, databases, and end user computing tools and programs, including proficiency in various software like Microsoft Windows, Email, Internet browsers, Instant Messenger, and Office (Word, Excel, etc.)
- Must possess basic reading and arithmetic skills (reading and math comprehension)
- Must possess above average verbal and written communication skills
- FACETS claims Coding
- Facets claims processing
- Prefer FACETS adjustment backgrounds
- Must have a high school diploma or GED.
- Must perform all duties in compliance with HIPAA regulations. May be required to work a 40 hour work week and/or mandatory overtime.
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.
And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.
