Medical Claims Processor – Managed Care
** This is a Full Time, Benefits Available, CONTRACT-TO-HIRE opportunity, expected to last several months before converting into a Permanent position! **
Claims Processor Job Summary:
Claims Processor Background Profile:
- Process claims for medical necessity, coding and assure payment per the terms of the contract, member benefits and authorization.
- Research and resolve complex verbal and written providers’ claims inquiries
- Provide technical review of claims and medical records including records submitted by providers and internal records provided in electronic healthcare data bases.
- Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing.
- Direct and educate provider services and provider relations staff with the claims reprocessing notification, utilizing knowledge of provider billing and claims processing.
- Identify needs and conduct additional claims training to internal departments.
- Apply knowledge of medical bill analysis relating to state and federal regulations affecting medical billing practice.
- Review claims to identify any potential third party or workers’ compensation liability and inform management.
- Communicate with appropriate internal staff when identifying questionable billing practices or third party collection opportunities.
- Requires graduate of high school or equivalent education; Associate degree preferred.
- At least 1-2 years direct experience as a claims processor / claims reviewer /physician biller required; will consider other healthcare support experience.
- Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred.
- Experience with Medicaid or Medicare claims preferred.
- Strong analytical mind, with problem solving skills, an aptitude for accuracy, and attention to detail.
- Ability to interpret, analyze and summarize large data sets and develop reports.
- Basic computer skills required, to include Microsoft Office, healthcare software, and data entry.