Medical Claims Processor
SpotlightStaff.
com SpotlightStaff.
com Rossville, GA Rossville, GA Full-time Full-time $15 - $22 an hour $15 - $22 an hour 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:
$15.
00 - $22.
00 per hour Expected hours:
40 per week Schedule:
8 hour shift Monday to Friday Ability to commute/relocate:
Rossville, GA 30741:
Reliably commute or planning to relocate before starting work (Required)
Experience:
ICD-10:
1 year (Preferred) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
com SpotlightStaff.
com Rossville, GA Rossville, GA Full-time Full-time $15 - $22 an hour $15 - $22 an hour 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:
$15.
00 - $22.
00 per hour Expected hours:
40 per week Schedule:
8 hour shift Monday to Friday Ability to commute/relocate:
Rossville, GA 30741:
Reliably commute or planning to relocate before starting work (Required)
Experience:
ICD-10:
1 year (Preferred) Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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