Job Description Branch ID:5114Review claims for correct internal data entry and make necessary changes.
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 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 Phoenixresumes@staffmark.com
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