What are the responsibilities and job description for the Claims Processor II position at Optum?
Claims Processor II
Northwest Physicians Network is now offering qualified candidates an opportunity to join our team as a Claims Processor II. Our company values innovative problem solvers, promotes personal and professional growth and provides a supportive working environment that affords all its employees a healthy work/life balance.
The Claims Processor is responsible for analyzing and adjudicating routine and complex medical claims while maintaining production and quality standards. Medical claims processing experience is a must. We are looking for someone with a strong attention to detail, excellent analytical thinking skills and who is adept at incorporating company procedure.
Northwest Physicians Network creates the opportunity for independent private practitioners to thrive in Washington State. By supporting clinical integration and data driven quality improvement, we have created a high value delivery network, making it possible for our providers to remain focused squarely on their patients.
Status: Regular, Full-time, FLSA Non-exempt
Primary responsibilities will include:
- Enters CMS 1500 information in the Professional Claims module of the EZ-CAP system
- Enters UB-04 facility information into Hospital Claims module of the EZ-CAP system
- Processes outcome to final adjudication and documents claim decision in the claim note
- Performs all functions required to complete batch of claims, includes verification of eligibility, referrals and authorizations
- Refers to Lead Processor with questions regarding claims processing
- Document claims information if necessary, as specified in Claims Policies and Procedures
- Keeps current on individual plan benefits for which claims are being adjudicated
- Brings to the attention of the Lead Processor any plan benefits which do not appear to be adjudicating correctly on the EZ-Cap system
- Daily management of pended claims report
- Review pre-audit claim reports to ensure accurate, thorough and timely adjudication of claims
- Documents plan information not currently available in EZ-Cap and forwards to appropriate staff
- Documents telephone inquiries in the claims notes
- Daily work assigned with an associated accuracy of 95%
Minimum Requirements:
- HS Diploma or equivalent, AA degree preferred
- 4 years’ experience processing medical claims
- Demonstrated knowledge of hospital/physician medical and billing terminology, Medicare, Medicaid Guidelines, RVS, CPT, HCPCS, RBRVS, DRG, ICD-10, Redbook, CMS 1500, UB-04, and per diem payments schemes
- Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
- Strong verbal, written communication skills and customer service skills gained through previous work experience
- EZ-CAP, Excel, MS Office 365 and SharePoint experience a plus
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.