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Form of workJob Description
Job Description:
Process complex claims for all lines of business. Process and understand COB adjudication. Understand and investigate TPL claims. Finalize fatal electronic interface claims. Initial and ongoing training of Claims Department staff. Assist in system upgrades and implementation of new or revised software related to claims adjudication. Special projects as assigned. Extensive knowledge of Epic AP Claims, CPT, ICD, ASA and HCPCS coding. Extensive knowledge of AWP calculation. Must have 95% audit results. Must have 5+ years claims experience. Must have production average of 15 claims per hour. Job standards to be performed at the EXPERT level.
REQUIRED QUALIFICATIONS:
• Minimum 5 years relevant experience.
• Expert knowledge of current HMO claim processing protocols and regulatory guidelines. Extensive knowledge of CPT, ICD, ASA and HCPCS coding as pertains to claim adjudication. Proficiency with MS Word, MS Excel, MS Outlook, and Internet Explorer.
• High school diploma or equivalent.
• Experience with Epic AP Claims claim processing system.
PREFERRED QUALIFICATIONS:
• Healthcare environment experience.
• 4-year college degree
COVID-19 Vaccine (Facility Guideline):
Required + Booster - Medical/Religious Exemptions only
Flu Vaccine (Facility Guideline):
Required - Medical Exemptions Only
