Medical Claims Specialist

3 weeks ago


Trenton, United States V R Della IT Services Private Limited Full time
*This position involves:*

· Follows adjudication policies and procedures to ensure proper payment of claims.

· Resolves pending claims based on Medicaid rules and regulation established for final processing.

· Resolves claims resolution and/or adjustments/voids.

· Processes claim adjustments through Reversal/Replacement requests submitted by providers.

· Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.

· Meets established production requirements consistently.

· Maintains an accuracy rate of 98% or better.

· Processes financial transactions.

· Review/Resolve LTC Production Reports.

· Data entry of LTC transactions.

· Monitor processing time & unfinished work on a daily basis.

· Process refund/return checks.

· Assist with monthly distribution of LTC TADS.

· Contributes a positive attitude to the team in order to meet department goals.

· Supports all departmental initiatives in improving overall efficiency.

· Assist in monitoring and timely processing of special batches

*Requirements*

· Basic knowledge of Microsoft Office Outlook, Word and Excel

· General knowledge of PC

· Good working knowledge of medical claims systems

· Knowledge of CPT/HCPCS and ICD9 coding procedures and guidelines

· Mathematical background a plus

· Good verbal and written communication skills

· Maintain regular attendance based on agreed-upon schedule

· Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

· Ability to establish and maintain positive and effective working relationships with
coworkers, clients, members, providers and customers

#Medical1

Job Types: Full-time, Contract

Pay: $23.50 per hour

Benefits:
* Dental insurance
* Health insurance
* Vision insurance
Schedule:
* 8 hour shift
* Day shift

Experience:
* Medical Claims: 2 years (Required)
* CPT/HCPCS and ICD9: 2 years (Preferred)
* Healthcare: 2 years (Required)

Ability to Relocate:
* Trenton, NJ 08610: Relocate before starting work (Required)

Work Location: In person

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