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

Job Description

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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 II

Department : Claim Services

FLSA Status : Full time, Non-Exempt

Salary Level : 3

Position Summary :

Process and adjudicate for payment all assigned EDI (electronic data interchange) and / or Paper claims, which includes but are not limited to medical and vision claims submitted by rendering providers, facility inpatient, and outpatient hospital to meet the department’s established performance standards, State of Hawaii Revised Statutes’ claims turnaround and department’s payment accuracy.

Essential Duties & Responsibilities :

Help Claims Processor I review, and complete OCR validation of scanned claims as needed.
Review and process different types of electronic or paper medical claim forms (CMS 1500 / UB-04)
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.
Review and process CMS 1500 Out of State claims in accordance with UHA’s out of state network policy and requirement criteria from start to finish.
Re-pricing out of state CMS 1500 and UB04 claims, and process through QNXT using Out of state network.
Assist in updating and maintaining Claims Processing Policy and Procedure Manual
Help with basic training for Claims Processors when necessary.
Consistently maintain regular and reliable attendance
Perform other duties as assigned and asking for additional duties when workload permits.

Required Education and Experience :

The 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.

Understanding of medical billing, medical terminology, and / or medical coding i.e. familiarity with electronic and paper CMS 1500 and UB04 Forms

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.

One year of Medical Insurance Claims Processing experience

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.

Physical Demands / Working Conditions :

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

See Associate Handbook – Employment Policies – Position Descriptions for general work environment.

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

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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Claim Processor II

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