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Claims Examiner I

3 months ago

Bakersfield, United States Universal Healthcare MSO LLC Full time
Job DescriptionJob DescriptionDescription:

Position Summary:

This position will be responsible for entering medical claim information into the various databases in a timely and accurate fashion. Responsible for the verification of all claims that are scanned into one of three families Anesthesia, COB, and Special batches. The Claims Coordinator will verify each claim in the batch and the system will prompt the verifier to audit certain fields for accuracy and completeness


Compensation:

The initial pay range for this position upon employment commencement is expected to be between $35,360.00 and $52,000.00 annually, translating to $17.00 to $25.00 per hour. However, the base pay offered may be adjusted based on individualized factors, including the candidate's education, certifications, skills, and experience. We value exceptional talent and strive to provide competitive compensation packages tailored to attract and retain top candidates like yourself.


Job Duties and Responsibilities:

• Mail Processing: Receive, sort claims and supporting documents according to company policy and procedures.

• Identify claims lacking required information.

• Scan, track and log all daily mail according to departmental policies and procedures.

• Accurately identify and sort provider dispute • Perform basic management of electronic files (i.e., print, copy, scan, transfer and delete).

• Enters data for envelopes, labels, form letters and correspondence.

• Data Entry: Input and maintain accurate records of all incoming and outgoing documents, including claims, applications, and supporting documents.

• Consistently meet internal, external, and governmental timeliness standards in processing claims to ensure prompt and efficient service delivery.

• Maintain compliance with established production and quality standards, ensuring accuracy and efficiency in claim processing.

• Work independently on assigned tasks and activities based on established policies and procedures, demonstrating autonomy and accountability.

• Ensure accurate and proper denial processing in the system for claims deemed inappropriate for payment.

• Works with numbers (i.e., add, subtract, multiply and divide).

• Detects and correct errors.

• Other related duties as assigned.



Requirements:

Qualifications:

• Excellent attention to detail, organization, and communication skills.

• High School diploma or equivalent.

• Knowledge of professional and institutional claim processing procedures, including COB (Coordination of Benefits)/TPL (Third Party Liability)/WC.

• Performs high volume data entry.

• Basic understanding of claims processes and workflows.

• Familiar with office equipment (including a photocopy machine, scanner, facsimile machine, etc.)

• Proficiency in MS Excel, Word, and Outlook.

• Ability to type 60 Words per Minute (WPM) or 10,000 Keystrokes per Hour (KSPH).

• Minimum of one year of practical experience or successful completion of an accredited vocational program in medical office and/or medical billing preferred.

• Ability to work independently and as part of a team in a fast-paced environment is essential.


Other Requirements:

• Possession of a valid driver's license.

• Proof of state-required auto liability insurance