About this role
Role Overview
- Determines accuracy and completions of claim information. Entry/verifies claims data.
- Resolves claim edits, review history records, and determine benefit eligibility for service.
- Reviews payment levels to arrive at final payment determination.
- Meets all production and quality standards, maintaining workques according to department standards.
- Effectively communicates with internal and external staff.
- Elevates issues to next level of supervision, as appropriate.
- Ensures accuracy of data entered and record maintenance.
- Attends all required training classes, demonstrating proficiency and ability to learn.
Requirements
- High School diploma/GED
- One (1) year of experience working with medical or institutional claim data entry OR One (1) year of customer service experience.
- Associate Degree in related healthcare field preferred.
- Two plus years of medical or institutional claims processing and customer service experience preferred.
- Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
- Ability to take direction and to navigate through multiple systems simultaneously.
- Knowledge and understanding of medical terminology, third party payors and insurance preferred.
- Requires attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
Benefits
- Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
- Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC