RESPONSIBILITIES

Process new claims or modify existing claims according to the appropriate and applicable action Analyze claims to determine appropriate action to approve or deny a claim for payment Determine accurate payment criteria for clearing pending claims based on defined policies and procedures Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims Review and address provider inquiries regarding claim adjudication Ability to understand and apply knowledge of medical coding (if applicable) and various medical claims forms to the claims process Demonstrate ability to work on high volume of repetitive claims Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards

 

QUALIFICATIONS

2 to 5 years of medical claims processing experience Experience in Blue Card or Blue Squared is required Experience with medical coding to include diagnosis coding and terminology is an advantage Knowledge in US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI. HIPAA protocol understanding is a must Ability to multi-task and follow documented claims processes with minimal supervision Excellent verbal and written business communication skills required Strong attention to detail and the ability to make appropriate decisions based on information presented