Job description
Job Summary:
Exposure to general ledger. Ability to review, audit and process invoices, and identify errors.
Process claims involving medical and/or surgical services; screens for complete member/provider information
Applies administrative policies when necessary, utilizing the claims processing manuals
Authorizes the generation of letters/questionnaires to providers to obtain additional information
Reviews descriptions of services on claims to determine validity of charges of the presence of errors
Evaluates and examines claims pended by the system due to contractual and/or payment discrepancies
Maintains production and quality goals established for the department
Performs other related duties, i.e., maintaining individual production counts, updating manuals and reference materials, attending all refresher training seminars
Skills:
Required Skills & Experience:
Experience with intermediate PC applications.
Must have decision making, problem solving and time management skills with two (2) years of experience.
Minimum 2 years experience in the healthcare insurance industry with knowledge of integrated claims processing
Proficient Data Entry Skills
Through knowledge of medical terminology, CPT, ICD-p, and Revenue Codes
Education:
Required Education:
High School Diploma.
OR
GED.
Associates Degree or any combination of education/experience
Languages:
English
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