What are the responsibilities and job description for the Medical Claims Processor position at SMART-MTA Trust Fund?
Claims Processor- Self Funded Medical Plan Healthcare
Job Description
This position requires a detail-oriented individual who can analyze & process claims while providing exceptional customer service. Experience with medical coding, Coordination of Benefits guidelines, and EOB interpretation. Requires two to five years of claims processing experience. Knowledge of CPTs, ICD-10 codes, UB/billing, and COB guidelines. Strong verbal, writing, & time management skills. Proficient in Microsoft Office.
Typical claims processor duties:
- Evaluating and processing health claims in accordance with claims policies and procedures
- Reviewing and analyzing internal policies to determine the extent of the company’s liability and entitlement
- Responding to inquiries from medical providers, members, and other entities
- Communicate effectively with members, medical providers, and legal representatives
- Utilize software to document claims processing activities and maintain accurate records
- Collaborate with team members to improve processes and enhance the overall efficiency of the claims department
- Strong organizational skills to manage multiple claims efficiently while meeting deadlines
- Excellent customer service skills, demonstrating empathy and professionalism in all interactions
- Understanding of HIPAA, Cyber Security, and other PHI patient confidentiality regulations
Summary
As a Medical Claims Processor, you will be essential in managing and processing medical claims efficiently while ensuring compliance with industry regulations such as HIPAA. Reporting to the Claims Manager, your core skills in medical coding, and medical terminology will be vital in accurately interpreting and entering claims data. Your premium skills in ICD-10, CPT coding, and medical billing will enhance your ability to resolve discrepancies and optimize reimbursement processes. Strong organizational skills and customer service orientation will enable you to effectively communicate with healthcare providers and membership, contributing to the overall success of our healthcare operations.
Job Type: Full-time
Pay: $24.00 - $28.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work Location: In person
Salary : $24 - $28