Claims Processor

Job Description

Job Description

Responsible for accurate review and input of claims in accordance with outside regulation, internal production standards and contractual obligations of the organization.

Duties and Responsibilities

1. Accurately review all incoming claims to verify if required fields are populated.

2. Process claims information into the computerized claims adjudication system.

3. Ability to process claims in the allotted time based on departmental policies and procedures.

4. Maintain all required documentation of claims processed and claims on hand.

5. Ability to keep track of pending claims while maintaining timeliness.

6. Maintain production standards of manually processed claims; CMS-1500 minimum of 90 / day and UB-04 minimum of 50 / day. Production standards may vary based on claim type and detail.

7. Respond to and resolve email inquiries in a timely manner.

8. Work collaboratively with other departments on resolving claim issues.

9. Provide backup for other processors and examiners within the department.

10. Perform additional duties / tasks assigned by leadership.

11. Promote a spirit of cooperation and understanding among all personnel.

12. Attend organizational meetings and trainings as required.

13. Adhere to organization and departmental policies and procedures.

14. Adhere to MedPOINT Management’s Core Values : Accountability, Community, Celebration, Integrity, Innovation, and Collaboration.

Minimum Job Requirements

High school diploma or GED.

Skill and Abilities

• Knowledge of computers, 10 Key, and MS Office (e.g. Outlook, Excel, Word).
• Exceptional attention to detail and accuracy.
• Ability to be flexible in high volume setting.
• Critical thinking and problem solving.
• Strong interpersonal, written, and verbal communication skills.
• Ability to manage time effectively, set priorities, and meet deadlines.
• Ability to learn and adapt to change.
• Receptive to instruction and constructive criticism.