Medical Claims Processor - Chandler, AZ
Chandler , Arizona
November 20, 2017
Job Description Branch ID:5114

Pay Rate/Salary: $15.00-16.00 / Hour
Do you want to work for a GREAT company in Chandler, AZ? Do you want a job that will lead to a permanent position? Do you have experience working as a Claims Processor? You MUST have experience with HCFA 1500 and UB92's! We have the job for you! In this role you will:

  • Review claims for correct internal data entry and make necessary changes.

  • Review claims for correct provider coding information regarding appropriateness of reported services and billing practices.

  • Request additional information needed to complete adjudication of claim-e.g., records and/or x-rays, clarification of submitted billing information.

  • Review claims for necessity, limitations and exclusions based on claim policies and procedures.

  • Determine and enter appropriate benefit/adjudication coding based on subscriber's plan benefits-e.g. explanation codes, denial codes, pricing structure, accumulators, system overrides.

  • Reprocess claims when necessary.

  • Document subscriber, provider and group files when appropriate for audit trail.

  • Provide support to internal departments.

  • Assist internal associates with claims related questions and issues.

  • Identify reoccurring problems and provide feedback to management to effect change.

  • Conduct claim specific research to resolve outstanding provider issues

  • Research claim issues to identify root cause and determine corrective action to resolve issue, communicate findings, document findings for future use

  • Perform claims adjustments on claims incorrectly adjudicated

  • Job Requirements Education:
    High school diploma or equivalent.

    Two or more years of prior experience in health insurance claims processing. Medicare claims experience preferred.

    Knowledge, Skills & Abilities:
    �1 to 2 years of claim processing experience in HCFA 1500 and UB92s
    �Strong analytical and problem solving skills.
    �Excellent communication skills (oral, written, and presentation).
    �Ability to manage workflow and meet deadlines on a consistent basis.
    �Ability to use Microsoft Office software proficiently.
    �Individual must possess proven organizational and interpersonal skills.
    �Individual must possess the ability to collaborate with others and work effectively within a team environment.
    �Knowledge of medical terminology required.
    �Ability to interpret varied insurance contracts, both member and provider.
    �Ability to work independently and as part of a team to accomplish unit goals.
    �Ability to handle varied workload.
    �Knowledge of ICD-9 coding, CPT coding

    To apply, please send your resume to

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