What are the responsibilities and job description for the Claims Processor CSR position at DELTA HEALTH SYSTEMS MCC?
Job Details
Description
Delta Health Systems, one of the leading Third Party Administrators (TPA) for self insured programs in the country with a reputation for flexibility, innovative services and outstanding customer service is looking for an innovative, self motivated, dedicated individual to fill the position of:
Claims Processor / Customer Service Rep.
POSITION RESPONSIBILITIES
- Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy and Department guidelines
- Key all final information for claims release into computer
- Respond to telephone customer inquiries verifying eligibility, explaining coverage, quoting benefits and advising on the status of claims
- Maintain information files, worksheet records, benefit quote documentation
- Establish and maintain COB files, applies COB payments for final claim payment
- Research and determine proper CPT procedure and ICD-9 Diagnosis Codes
- Research and respond to written correspondence from participants, providers, and local unions/employers
- Prepare transmittal and send claims to Benefit Review for processing instructions
- Work effectively to achieve acceptable production and accuracy standards
- Display maturity, composure and ability to operate under stress conditions
- Perform other duties as assigned
- Specialty duties include: Enter dates of service on dental pre-determinations. Process voided checks and refund checks. Maintain weekly disability files and process claims.
KNOWLEDGE AND SKILL
Eighteen (18) months experience as a Claims Processor or similar function. Must have a broad knowledge of medical terminology and must possess excellent written and oral communication skills. Must possess good judgment skills and ability to interpret Department guidelines and contractual benefits and possess a high school diploma or equivalent. Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience.
Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package.
Equal Opportunity Employer
Qualifications
Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package.
Equal Opportunity Employer
Salary : $19 - $21