Claims Processor

Required:

* High School Diploma/GED

* Three (3) years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting

* Three (3) years of experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims

Preferred:

* Three (3) years of experience on an automated claims processing system (Epic Tapestry preferred)

* Bachelors degree in healthcare field or related field

Job Duties and Responsibilities:

• Responsible for efficiency standards for number claims completed and for accuracy of entries

• Handles in a professional and confidential manner all correspondence

• Supports core values, policies, and procedures

• Obtains and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.

• Acquires daily workflow via reports or work queue and incoming phone calls

• Research claims for appropriate support documents

• Analyzes and adjusts data, figures out appropriate codes, fees and ensures timely filing and contract rates are applied

• Responds and documents resolution of inquiries from internal departments

• Assists Finance with researching provider information to resolve outstanding or stale dated check issues

• Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases

Job Type: Contract

Salary: $27.00 - $28.00 per hour

Expected hours: 40 per week

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• In-person

Experience:

• claims processing system: 3 years (Required)

Work Location: In person