What are the responsibilities and job description for the Claims Processor position at EliteTechnical?
Elite Technical is seeking a Healthcare Claims Processor, with specific knowledge around Claims Adjudication! The selected candidate will review and adjudicate paper / electronic healthcare claims from providers. Determines proper handling and adjudication of claims following organizational policies and procedures.
ESSENTIAL FUNCTIONS :
60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and / or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.
10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.
This position is a contract to permanent opportunity with our client. Although 100% remote, we are seeking candidates that reside in one of the follow states : DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL. Want to learn more? Then you should contact Elite Technical right away for consideration!
Required Skills
- Education Level : High School Diploma or GED is required
- Experience : 3 years of Healthcare Claims processing knowledge, along with overall claims billing and medical terminology experience
- Must have experience working in high volume claims adjudication environment (200 daily)
- Must have strong Claims Adjudication experience
- Diagnosis codes (CPT / ICD) knowledge is required
- SW Tools : MS Office (Outlook, Excel, MS Teams)
- Big Plus : Luminx (for claims processing) and / or TPA experience
