Medical Claims Processor (On Site)

*$1,500 Sign-on Bonus*

JOB SUMMARY – The Medical Claims Processor is responsible for the accurate and timely adjudication of all electronic and paper Medical Claims according to the Family Medical Care Plan benefit plan provisions and guidelines.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Follow benefit plan documents and established departmental policies and procedures to adjudicate claim within policy provisions
• Determine whether to pay, deny, or pend claims within policy guidelines and adjudicate claims accordingly - processer must be able to review and research claims by navigating multiple computer programs and accurately selecting the data/information necessary for processing (e.g. applicable benefits, coding, prior authorizations)
• Obtain and maintain a working knowledge of the multiple benefit schedules, as well as a clear understanding of the eligibility system and claim system
• Other duties as assigned

PERFORMANCE STANDARD

• Standard Processing: 13 claims/hour
• COB/Medicare: 8 claims/hour
• Adjustments: 6 claims/hour
• No more than 50 Claims pended at a time

REQUIRED AND PREFERRED KNOWLEDGE, SKILLS, AND ABILITIES

• Minimum 1 year processing Medical Claims is required, 2 years preferred
• Bachelor’s Degree or equivalent experience required
• Must have a thorough working knowledge of commonly used claims examination concepts, practices and rules, ICD and CPT/revenue coding and network contracts
• Must have a thorough working knowledge of medical terminology
• Must have fundamental knowledge of coordination of benefits, including for Medicare claims
• Must be able to type 40 wpm
• Dependability – ensures timely arrival and consistent attendance to support the achievement of the team’s goals
• Excellent written & verbal communication skills
• Proficiency in MS Office is required
• Excellent time management skills and ability to multi-task and prioritize work
• Strong attention to detail and problem solving skills
• Strong organizational and planning skills
• Demonstrates ability to manage complex issues while maintaining a flexible, positive, and cooperative demeanor
• Responds in a timely manner to operations leaders and stakeholders to facilitate informed decision-making
• Troubleshoots assigned issues, gathers evidence, and investigates all relevant information with vendors and internal departments to resolve the problem in a cooperative and collaborative manner

EQUIPMENT REQUIRED

• Desktop computer, keyboard, calculator, printer/copy machine/scanner, Right Fax.

WORK SCHEDULE

• In-office
• 40 hours, Monday through Friday, 8am - 5pm with daily 1 hour unpaid lunch

Job Type: Full-time

Pay: From $19.50 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• medical insurance Claims Processor: 1 year (Required)

Work Location: In person