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Claims Processor
2 months ago
Now Hiring Healthcare Claims Processor for a top managed care organization
Must live in Pacific Time or Mountain Time Zones
Hours: 8:00AM – 4:30PM for first two weeks then can start as early as 6:30AM once independent. Can choose own schedule after training. Monday through Friday
Pay Rate: $17.50 per hour
Duties:
- Learn how to research why medical claims are stuck in the Pre-Payment Review Database. (PPRD) and clear the issue such as a member match problem so the claim can go to a trained Claims Analyst for adjudication.
- Will train as claims processor if PPRD training and work is at quality and production standard within 4 months.
- Organize and work with detailed office or warehouse records, using computer to enter, access, search and retrieve data.
- Prepare and review insurance claim forms and related documents for completeness.
- Provide customer service, such as giving limited instructions on how to proceed with claims or providing referrals to other facilities or contractors.
- Review claims to determine whether or not claimant is covered under a policy, review policy to determine coverage, and evaluate the extent of a settlement.
- Authorize claim payments, set reserves on payments, ensure timely disbursement of funds, coordinate or conduct investigations on claims, identify claims with possible recovery from third parties, and consult with attorneys, doctors, and agents in regards to the disposition of complex claims
Requirements:
- Medical Claims processing.-1 year exp
- Medical billing & coding knowledge/exp
- Must have high speed internet connection at home
- Research capability
- Self-starter, attention to detail
