Job Description
In this Role you will be Responsible For
- Reviewing and researching insurance claims to determine possible payment accuracy.
- Validating Member, Provider and other Claims information.
- Determining accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
- Coordinating Claim Benefits based on the Policy & Procedure.
- Maintaining productivity goals, quality standards and aging timeframes.
- Scrutinizing Medical Claim Documents and settlements
Requirements for this role include:
- 1 to 2 years of Claims Adjudication experience that required you to review claims rules and workflows.
- 1 to 2 years of experience processing claims that required a working knowledge of HCPCS, ICD and CPT codes
- 1 to 2 years of experience that required a knowledge of healthcare insurance policy concepts including In Network, Out of Network providers, Deductible, Coinsurance, Co-pay, Out of Pocket, Maximum inside limits and Exclusions, State Variations.
- Ability to communicate (oral/written) effectively in English to exchange information with our client.