JOB DESCRIPTION
ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner
companies to source qualified talent for their open roles. The following
position is available to Veterans, Transitioning Military, National Guard and
Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If
you have the required skill set, education requirements, and experience, please
click the submit button and follow the next steps.
Must have:
Medical/healthcare claims processing experience
Experience with list of ICD 9/10 codes and CPT
Responsible and accountable for the accurate and timely processing of all
claims. Claims must be processed with a high level of detailed quality and in
accordance with claims payment policy and by the terms of our customer/provider
contractual agreements.
Adjudicates claims and adjustments as required.
Resolves claims edits and suspended claims.
Maintains and updates required reference materials to adjudicate claims.
Provides backup support to other team/group members in the performance of
job duties as assigned.
Manually prices claims with various tools and processes to pay the claims.
Utilizes reference materials and analyzes updated materials to adjudicate
claims. This includes reviewing material updates daily and sharing feedback or
suggestions if any concerns arise.
Partners with the Quality team for clarity on procedures and complex claims
and receives coaching from leadership.
The job duties listed above are representative and not intended to be
all-inclusive of what may be expected of an employee assigned to this job. A
leader may assign additional or other duties which would align with the intent
of this job, without revision to the job description.
#LI-Remote
ADDITIONAL QUALIFICATIONS/RESPONSIBILITIES
Demonstrated ability to navigate computer applications.
Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
Demonstrated basic analytical skills.
Basic written/oral communication skills.
Demonstrated reading comprehension and ability to follow provided directions.
General Job Information
Title
Claims Processor II
Grade
19
Work Experience - Required
Claims
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$37,725
Salary Maximum:
$56,595