Medical Claims Examiner Trainee

2 weeks ago

Gladstone, United States WPAS Inc Full time

*Medical Claims Examiner Trainee: *
* *Union Role*
* *In-Office*
* *$18-20*
Attention certified medical coders, medical billing specialists, medical front office staff: Entry level position with established medical claims payer. Great opportunity to get your foot in the door. Long-term position with career growth opportunity.
*Job Purpose:*
Under limited supervision of the supervisor this position will apply techniques to process routine and complex claims, analyze expenditures and make recommendations for third-party liability claims.
*Job Duties:*
* Work with trainer and/or assigned co-worker to learn and perform review of plan documents and procedures to apply plan provisions, limitations and exclusions when making benefit determinations.
* Learn to request information to complete or review claims using standard procedures and letters, and asks questions as needed.
* Must demonstrate ability to learn and grow with continuous improvement and ability to increase average daily claim production while maintaining accuracy and quality.
* Performs computations and processes claims independently up to the dollar threshold set by the trainer not to exceed the job classification maximum of $1,500.00.
* Learns to perform duties and prepare to become a Claims Examiner by meeting training objectives and expected production metrics.
* Communicates efficiently by telephone, in writing or in person with all personnel, members, providers, external vendors or others regarding claim benefit questions or information.
* Communicates with the Quality Assurance Supervisor in conjunction with their trainer as necessary to request and receive data on pending claims.
* Learns to apply procedures to third-party liability claim claims.
* Exercises professional judgment on daily tasks and seeks approval from supervisor or trainer when faced with new or unfamiliar tasks.
* Maintain a 10 business-day turnaround time on assigned claim responsibilities.
* Maintain and update a pending file with follow-ups on correspondence as required.
* Ability to meet production and quality goals on a consistent basis as outlined within training.
* Routes claims requiring review to the assigned Claim Adjuster Senior II.
* Demonstrates knowledge of assigned duties as well as the legacy and the recently migrated claims processing system.
* Perform other duties as assigned.
*Minimum qualifications:*
* Certified medical coder, or 6 months minimum experience in medical coding, billing, or front office.
* Working knowledge of basic office equipment with minimum keyboard speed of 35 words per minute.
* Positive interpersonal communications with internal and external clients and vendors.
* Demonstrated ability to keep calm and positive within all communications.
* Proven ability to accurately and timely review and edit documents.
* Utilize computer, phone systems and reference materials to be able to effectively perform the essential functions of the position.
* Previous experience utilizing Microsoft office software
* High school diploma or G.E.D
*Preferred qualifications*
* 2 years of college experience in a related field- do not have to have an associate degree
Job Type: Full-time
Pay: $18.08 - $20.32 per hour
Expected hours: 37.5 per week
Benefits:
* Dental insurance
* Health insurance
* Paid time off
* Retirement plan
* Vision insurance
Schedule:
* Monday to Friday
Ability to Relocate:
* Gladstone, OR 97027: Relocate before starting work (Required)
Work Location: In person

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