Medical Claims Processor

Overview:

We are seeking a skilled and detail-oriented Claims Processor to join our healthcare team. The ideal candidate will be responsible for processing medical claims in a timely and accurate manner, utilizing their knowledge of medical coding and terminology to ensure seamless communication with healthcare providers and insurance companies. This position requires a strong understanding of medical billing and collection procedures, as well as the ability to work effectively in a fast-paced environment.

Responsibilities:

• Processer will follow benefit plan documents and established departmental policies and procedures to adjudicate claim within policy provisions.
• Determine whether to pay, deny, or pend claims within policy guidelines and adjudicate claims accordingly - processer must be able to review and research claims by navigating multiple computer programs and accurately selecting the data/information necessary for processing (e.g. applicable benefits, coding, prior authorizations).
• To obtain and maintain a working knowledge of the multiple benefit schedules, as well as a clear understanding of the eligibility system and claim system.
• Work on special projects as requested by Management

Qualifications/Requirements:

Must have a minimum of 2 years of experience processing medical claims.

• Must have experience with a major medical carrier.
• Must have a thorough working knowledge of commonly used claims examination concepts, practices and rules, ICD and CPT/revenue coding and network contracts.
• Must have a thorough working knowledge of medical terminology.
• Must have fundamental knowledge of coordination of benefits, including for Medicare claims.
• Must have ability to work with department manager to address escalated claims issues that require research and accuracy.
• Must have ability to assist Customer Service Reps with claims/benefits questions.
• Must have strong computer keyboard and navigational skills.
• Must have ability to maintain confidentiality at all times.
• Microsoft Office – proficient in Word, Excel, and Outlook.
• Dependability – ensures timely arrival and consistent attendance to support the achievement of the team’s goals.
• Accuracy – strives for the highest level of accuracy possible from the tools used and the processes performed.
• Verbal Communication –is able to communicate professionally, politely, clearly and effectively with outside customers as well as coworkers and management.
• Written Communication- uses excellent spelling, grammar, and punctuation skills and follows appropriate email etiquette.
• Flexibility – takes direction with minimal amount of disruption.
• Initiative/Motivation – demonstrates initiative in meeting team goals and shows motivation towards service for employers and for team members. Follows up on outstanding contacts and issues with little guidance.
• Judgment/Maturity - exercises good judgment and acts in a mature manner while performing tasks assigned. Exercises maturity when in contact with the outside community regardless of external behavior.
• Knowledge – learns the systems and processes needed to perform daily tasks. Know and implement proper procedures when in contact with a hostile or threatening party either by phone or written correspondence.
• Math – compute all necessary numbers for processes performed.
• Problem Solving – solves day to day problems and determines when these problems need to be escalated to the supervisor level.
• Teamwork – works as an efficient and effective member of the team.

Skills:

- Medical coding and billing
- Medical records
- ICD-10 and DRG coding systems
- Medical terminology
- Medical office software and electronic health records systems
- Systems and technology
- Medical collection

Job Type: Full-time

Pay: $28.00 per hour

Expected hours: 40 per week

Work Location: In person

Salary : $28