What are the responsibilities and job description for the Claims Adjudicator position at Independent Health?
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Overview
The Claims Adjudicator shall be responsible for adjudicating claims against established criteria and address incoming inquiries to ensure that all claims are paid in support of established rules, regulations, performance guarantees and department targets.
Qualifications
High school diploma or GED required.
One (1) year of experience in customer service, medical claims processing, medical billing or collections required.
Knowledge of medical billing procedures; CPT and ICD-9 coding and medical terminology knowledge preferred.
Proficiency with data entry skills and Microsoft Office products.
Demonstrated experience with independent decision making to include effective problem resolution.
Solid organizational skills with attention to detail and follow through.
Good written, verbal and interpersonal communication skills. Demonstrated ability to effectively communicate with internal and external customers.
Must be able to work collaboratively. Flexibility to work additional hours as needed.
Ability to meet or exceed all department goals to include accuracy and productivity.
Proven examples of displaying the IH values : Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Essential Accountabilities
Technical Proficiency :
Adjudicate claims based on established policies and procedures for facility, professional, member submitted, pharmacy and dental claim edits. This is inclusive for both in and out-of-network benefits.
Review vouchers / explanation of payments to identify and resolve claims related issues.
Continually meet or exceed department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication.
Analyze, identify and research, as needed, edits which demonstrate inconsistency in regards to policy, payment issues and coding issues.
Maintain current contract, summary plan description and benefit knowledge.
Ability to adhere to departmental deadlines and turn-around times, in order to be compliant with State and Federal regulations.
Communication :
- Effective written, verbal and interpersonal communication with other departments within Independent Health to resolve problems related to claims payment.
Immigration or work visa sponsorship will not be provided for this position
Hiring Compensation Range : $18.00 hourly
Compensation may vary based on factors including but not limited to skills, education, location and experience.
In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.
As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here () for additional EEO / AAP or Reasonable Accommodation information.
Current Associates must apply internally via the Job Hub app.
The Independent Health Family of Companies, headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio includes Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, Care for You and the Independent Health Foundation.
Our culture sets us apart. Our core values drive who we are and the work we do. As a member of our family, you’re part of something special, in your work and in the community.
We understand and appreciate that everyone has unique experiences, perspectives and identities which is why we pledge to create a safe space where all people and ideas are welcomed. We are here to continue learning and to generate important dialog.
We are committed to doing what matters most - reaching out, working together, and caring for our community. A healthy community benefits everyone who lives in it. You too can be part of making difference in the lives of others, together we achieve so much more. Please click here () to view our Community Reports.
Apply today and join us on the journey to a happier, healthier, and more inclusive community.
We are a drug-free workplace. We are committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans. An applicant for employment in need of an accommodation to participate in the application and recruitment process should contact Human Resources at : accommodations@independenthealth.com or Human Resources, 511 Farber Lakes Drive, Williamsville, NY 14221.
Please note, we do not accept unsolicited resumes. We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.
Salary : $18
