What are the responsibilities and job description for the Claim Processor I position at University Health Alliance?

Job Description

JOIN UHA’S TEAM

We focus on your health and pay 100% for your family's medical insurance and provide 20 days of paid personal time off during your first year!

Claim Processor I

Department : Claim Services

FLSA Status : Full Time, Non-Exempt

Salary Level : 2

Position Summary :

Responsible for validation of scanned claims. Process all assigned Electronic Data Interchange (EDI) and / or paper claims to meet the department’s established performance standards, and State of Hawaii Revised Statutes’ claims turnaround time and department’s payment accuracy.

Essential Duties & Responsibilities :

Optical Character Recognition (OCR) validation of scanned claims
Review and process different types of electronic or paper claim forms (CMS 1500 / UB-04)
Data entry and review of outsourced rejected claims
Analyzing and calculating coordination of benefit payments
Create claims processing system memo to identify, track, and pay or deny claims in accordance with the Third-Party Liability policy and medical benefits guide
Basic review and processing CMS 1500 Out of State claims in accordance with UHA’s out of state network policy and requirement criteria
Perform other duties as assigned and asking for additional duties when workload permits.
Consistently maintain regular and reliable attendance

Required Education and Experience :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Able to navigate through internal and external computer systems including Microsoft Word and Excel, and have proficient PC keyboarding skills

Able to use acquired skills & knowledge and willingness to learn new skills

Able to interpret group benefit plan coverages

Able to analyze and calculate Coordination of Benefits information

Knowledge of any medical claims processing software applications, preferred

Able to work as a contributing team member toward achieving management’s stated goals

High School diploma

One year of work experience in an office setting, preferably associated within the healthcare industry

Able to use ten key and typewriter by touch with a minimum of 10,000 keystrokes per hour

Preferred and Advanced Qualifications :

CPC (Certified Professional Coder) preferred not a requirement

Understanding of medical billing, medical terminology, and / or medical coding (i.e. familiarity with CMS 1500, UB04, EDI CMS 1500 and EDI UB04), preferred

Physical Demands / Working Conditions :

The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.

Frequent sitting, talking, hearing, use of a computer keyboard and monitor, reaching, bending, standing, and walking

Occasional climbing, stooping, kneeling, crawling, and crouching

Occasionally required to lift, move and / or carry up to 10 pounds

This position is eligible to work from home subject to management approval

Hours of Work

See Associate Handbook – Employment Policies – Work Schedule and Attendance

Equipment and Software Use

Please refer to Associate Handbook – Employment Policies – Position Descriptions for general list of equipment for that applies to all positions

Vehicles

None required

Only Hawaii residents will be considered for this position due to the need for availability for in-person duties when required.

Competitive compensation & excellent benefits offered

Visit our website at https : / / uhahealth.com / page / career -opportunities to apply and for details about vacant positions.

An Equal Opportunity Employer

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