Medical Claims Processor

JOB RESPONSIBILITIES

· Processer will 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).

· To obtain and maintain a working knowledge of the multiple benefit schedules, as well as a clear understanding of the eligibility system and claim system.

· Work on special projects as requested by Management;

QUALIFICATIONS/REQUIREMENTS

· Must have a minimum of 2 years of experience processing medical claims.

· 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 have ability to work with department manager to address escalated claims issues that require research and accuracy.

· Must have ability to assist Customer Service Reps with claims/benefits questions.

· Must have strong computer keyboard and navigational skills.

· Must have ability to maintain confidentiality at all times.

· Microsoft Office – proficient in Word, Excel, and Outlook.

· Dependability – ensures timely arrival and consistent attendance to support the achievement of the team’s goals.

· Accuracy – strives for the highest level of accuracy possible from the tools used and the processes performed.

· Verbal Communication –is able to communicate professionally, politely, clearly and effectively with outside customers as well as coworkers and management.

· Written Communication- uses excellent spelling, grammar, and punctuation skills and follows appropriate email etiquette.

· Flexibility – takes direction with minimal amount of disruption.

· Initiative/Motivation – demonstrates initiative in meeting team goals and shows motivation towards service for employers and for team members. Follows up on outstanding contacts and issues with little guidance.

· Judgment/Maturity - exercises good judgment and acts in a mature manner while performing tasks assigned. Exercises maturity when in contact with the outside community regardless of external behavior.

· Knowledge – learns the systems and processes needed to perform daily tasks. Know and implement proper procedures when in contact with a hostile or threatening party either by phone or written correspondence.

· Math – compute all necessary numbers for processes performed.

· Problem Solving – solves day to day problems and determines when these problems need to be escalated to the supervisor level.

· Teamwork – works as an efficient and effective member of the team.

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

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

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Relocate:

• Chickamauga, GA: Relocate before starting work (Required)

Work Location: In person