What are the responsibilities and job description for the Claims Processor position at KMM Technologies, Inc.?
Job Description
Job Description
Reach me on : Tel : 240-800-0056 | Email : rabina@kmmtechnologies.com
Position : Claims Processor
Location : Fairfax, VA #REMOTE
Duration : C2H
Job Description :
- Under direct supervision, reviews and adjudicates paper / electronic claims.
- Determines proper handling and adjudication of claims following organizational policies and procedures.
- Required Previously Experience in adjudicated 200-300 medical claims daily with accuracy of 98% or above for prior roles.
- Education Level : High School Diploma or GED
- Required one year experience processing claim documents
- 1-3 years Claims processing, billing, or medical terminology experience
- Demonstrated analytical skills, Proficient
- Demonstrated reading comprehension and ability to follow directions provided, Proficient
- Basic written / oral communication skills, Proficient
- Demonstrated ability to navigate computer applications, Proficient
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.
Required Skills :
MS Excel, Adobe Acrobat, MS Outlook, Teamwork, Customer Focused, Detail oriented, Organizational Skills, Problem Solving Skills, Time Management, Verbal Communication
Thanks & Regards,
LAXMAN
KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
Tel : (240) 800-0039 |Email : lax@kmmtechnologies.com
