Job Description:
• Research and verify complex claims information for accurate and timely claims processing
• Enter coded and other required information into claims systems
• Review and correct scanned claims documents
• Check claims for completeness and accuracy before final entry
• Identify and resolve inconsistencies and request missing information
• Ensure contract benefits are applied correctly
• Research procedural questions using supporting documentation and training manuals
• Identify incomplete adjudication instructions and suggest procedure updates
• Identify training issues and consult management when necessary
• Record daily production information including edits processed, hours worked, downtime, and special projects
• Reject, redirect, or return incomplete or inaccurate claims
• Maintain contact with internal departments, staff, providers, members, lawyers, insurers, and other external entities
• Perform other job-related duties within the scope of responsibilities
Requirements:
• High School Diploma or equivalent required
• Associate's degree preferred
• 1 year of related clerical or data entry experience required
• A medical office or medical coding diploma can be used in lieu of one year of experience
• Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC can be used in lieu of one year of experience
• Claims processing or claims coding experience preferred
• Must be able to enter data at 4000 keystrokes per hour
• Medical coding training preferred
• Must demonstrate critical thinking and problem-solving skills
• Familiarity with medical and health insurance terminology preferred
• Demonstrated verbal and written communication skills
• Must demonstrate PC skills including Microsoft Office (Word, Excel, Outlook, etc.)
• No licenses or certifications required
• Residency in or relocation to Louisiana is preferred for all positions
• Must pass background and pre-employment drug screening; employment restrictions apply to certain felony convictions involving dishonesty or breach of trust
Benefits:
• Employee resources to live well, be healthy, continue learning, develop skills, grow professionally and serve local communities
• Smoke- and tobacco-free company properties
• Reasonable accommodations for individuals with disabilities
• Pre-employment drug screening and background screening after an offer