What are the responsibilities and job description for the Medical Claims Examiner position at Global IT?
* Maintains database integrity in accordance with policies, procedures and guidelines as outlined by company policy. Researches and solves application problems to maintain a viable system.
* Maintains current in-depth knowledge of assigned applications’ functionality and participates in system upgrades and testing.
* Verifies member eligibility and benefits via health plan websites and/or other methods as appropriate.
* Completes benefit plan builds for all HMO Managed Care plans by completing specification imports with all appropriate benefits (copays, coinsurance, deductibles and MOOP).
* Responsible for contacting health plans for benefit interpretations and to obtain clarification for use in design.
* Works closely with EIS Personnel on EIS-related projects.
* Fosters two-way communication within department and with end-users.
* Uses Customer Relationship Management tool to communicate with internal departments to resolve issues and tasks pertaining to enrollment, eligibility and benefits and adhere to task turn-around times.
* Work eligibility work-queues for any eligibility and benefits issues.
* Determine coverage filing order using NAIC and CMS guidelines for Coordination of benefits.
* Works enrollment audit reports, and other system reports to make appropriate eligibility and benefit updates.
* Performs root cause analysis to determine issues related to eligibility and benefits or system errors
* Identifies issue trends and opportunities for improvement.
Job Type: Contract
Pay: $20.00 - $24.00 per hour
Schedule:
- Monday to Friday
Education:
- High school or equivalent (Required)
Experience:
- Medical claims eamination: 2 years (Required)
- medical coding (PCT, ICD-10, etc.): 2 years (Required)
Work Location: One location
Salary : $20 - $24