The focus of this position is to adjudicate, investigate and resolve claim issues for Network Health. Must have experience with ICD9, CPT Codes and HCFA 1500. Experience with workers compensation, TPA, slip and fall a plus.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Process claims in accordance with Network Health's policies and procedures.
- Must have experience with ICD9, CPT Codes and HCFA 1500.
- Maintain department production and quality requirements.
- Investigate and respond to providers regarding their claim issues.
- Assist in developing recommendations for improvements to the claim processing system.
- Interact with various operational departments to assure accurate and timely payment of claims in accordance with the plan's policies and procedures.
- Participate in special claim projects, as needed.
- Other duties, as assigned.
A little about us:
Founded in 1979, Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage.