Claims Processor

Description:

To adjudicate medical claims for payment in an accurate, timely, and efficient manner.

Essential Position Functions

• Process claims for payment on assigned accounts from aged report, adjudication queue, and internal and external requests.
• Assure claims are paid accordingly based on fee schedule, contract, group policy, and provider.
• Review written correspondence and medical notes to assure claims are paid accurately.
• Meet or exceed all Key Performance Indicator (KPI) quality and production goals.
• Reprocess claims as necessary.
• Answer claims questions from other departments.
• Identify and communicate system issues, billing patterns, training opportunities, etc. to the claims supervisor.
• Comply with all company policies and procedures.

Minimum Requirements of the Position

• High school graduate or equivalent.
• Prior claims processing experience preferred.
• 10 key proficient.
• Basic proficiency in Microsoft Word and Excel.
• Medical terminology and a basic understanding of ICD-10CM, HCPCS and CPT coding is helpful.
• Ability to work in a team environment.