Medical Claims Processor

1 week ago

Fairfax, United States Three Point Solutions Full time
Job DescriptionJob Description

Job Title: Medical Claims Processor I
Client: Health Care Industry
Duration: 12 months
Location: Fairfax, VA 22031

Purpose:
Under direct supervision, reviews and adjudicates paper/electronic claims. Ensures claims are handled according to organizational policies and procedures.

Essential Functions:

  • 60%:
    Examines and resolves non-adjudicated claims. Processes product/system-specific claims, calculates deductibles, and ensures timely payments. Uses automated systems to process and complete claims according to medical policy and contracts.
  • 25%:
    Conducts research and applies training materials, medical policies, and procedures to process claims accurately. Collaborates with the Quality team and leadership for clarity on procedures. Participates in ongoing training.
  • 10%:
    Completes daily productivity reports used for scheduling, quality improvement, and financial planning.
  • 5%:
    Collaborates with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

Additional Skills:
Claims Processing/Billing Experience, Team Player, Accuracy in Keying, Organization, Reliability

Qualifications:

  • Education:
    High School Diploma or GED required.
  • Experience:
    Less than one year of experience in processing claim documents required.
    Preferred: 1-3 years of experience in claims processing, billing, or medical terminology.

Knowledge, Skills, and Abilities:

  • Analytical skills Proficient
  • Reading comprehension and ability to follow directions Proficient
  • Basic written/oral communication skills Proficient
  • Ability to navigate computer applications Proficient

Additional Requirements:

  • Must disclose any event that makes them ineligible for work on Federal health care programs.
  • Ability to work in a fast-paced environment with changing priorities, deadlines, and workloads.
  • Must meet deadlines and handle multiple customer service demands effectively.
  • Ability to communicate positively with both internal and external customers, including challenging situations.

#ZR

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