Medical Claims Specialist
3 weeks ago
· 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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