Job description
Start Date will be in March 2023
Responsible for the adjudication of medical claims at all pend levels in an accurate and timely manner as required by corporate and departmental standards on accuracy and production.
- Responsible for the resolution of pended claims in an accurate and timely manner according to departmental processes, procedures and guidelines and in compliance with departmental and corporate standards for accuracy, quality and production.
- Responsible for resolution of system Batch Errors.
- Responsible for initiating inquiries to other parties as needed to address pended claims issues or resolving inquiries associated with claims adjudication.
- Perform other reasonably related duties, including special projects as assigned by immediate supervisor and other management staff as required.
- High School Diploma required. Associates or Bachelor’s degree in health care or related field preferred.
- One year of claims processing/claims resolution experience which included the use of CPT/ICD codes and standard health claim billing forms preferred.
- Associates or Bachelor’s degree in health care claims or billing may be accepted in lieu of actual claims processing experience.
- Ability to create or modify existing Microsoft Office Suite software (e.g. Word, PowerPoint, Excel, and Access) documents and reports required.
- Analytical problem-solving skills.
- Effective oral and written communication skills.
- Successful experience working in a team environment.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.
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