Hospital Claims Processor I

Our Hospital Claims Examiner will be responsible to run reports daily to process Contracted and Non-Contracted claims timely for Commercial and Senior members. Review PDR/Appeals/Re-Openings received to make determination. Any additional task provided by Supervisor/Manager/Director.

Qualifications:

· Must have a minimum of three years Claims experience processing hospital claims.

· Work independently as part of a team

· Strong organization skills: ability to multitask and properly manage time

· Preferred knowledge of Medicare and Commercial rules and regulations

· Knowledge of using Crystal Reports/EZ-Cap

· Knowledge of processing non-contracted/contracted claims

· Knowledge of processing PDR’s/Appeals

· Must have an understanding on how to read and interpret DOFR and Contracts

· Must understand how to read a CMS-1500 and UB-04 form

Skills:

· Must have effective communication, facilitation, interpersonal and professional diplomacy skills.

· Strong attention to detail with ability to manage multiple priorities while meeting deadlines.

· Able to Problem-solve, negotiate, and demonstrate independent decision-making.

· Strong communication skills in both oral and written form.

· Positive attitude and takes a team approach to management.

· Maintain strong skills in diplomacy, professionalism, and trustworthiness.

· Familiarity with Microsoft applications, which include the ability to learn new computer systems and applications.

· Ability to manage multiple priorities and projects.

· Detail oriented with desire for producing work with 100% accuracy.

· Excellent analytical and problem-solving skills.

Job Type: Full-time

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: In person

Salary : $20 - $25