Claims Processor II
4 weeks ago
PRINCIPAL RESPONSIBILITIES:
Under the direct supervision of the Claims Processing Supervisor and the general direction of the Manager, Claims Production, this position is responsible for the accurate review, entry and processing of all claims received for payment by AAH.
Principal responsibilities include:
• Research claims for completion and appropriateness.
• Review and handle rejected claims as necessary.
• Evaluate HealthSuite error screen and base payment determination using AAH claims processing guidelines.
• Utilize Claims Department policies & procedures, workflows, and manuals to meet Departmental production and quality metrics.
• Routinely exceed established Departmental individual production standards and collaborate with other Claims staff to ensure departmental compliance targets are met. The current production standard for this position is a minimum average of 17 claims per hour.
• Meet or exceed a financial and procedural accuracy standard of 97%.
• Review routine and moderately complex claims and edits to determine the appropriate handling for each including paying, denying, or suspending for Claims Processor II or Supervisor review.
• Manually price claims as needed.
• Communicate identified issues with claims and claims processes to Supervisor or Manager.
• Actively participate and collaborate with the entire department to continuously improve workflows and performance.
• Perform other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
• Process claims of a routine and more complex type using the claims processing system.
• Review and analyze claims for routing to appropriate queues for resolution.
• Routinely exceed Departmental performance and quality metrics.
• Comply with AAH's Code of Conduct, and all regulatory requirements.
PHYSICAL REQUIREMENTS
• Constant and close visual work at desk or computer.
• Constant sitting and working at a desk.
• Constant data entry using keyboard and/or mouse.
• Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 20 lbs.
Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:
• High School Diploma or equivalent is required.
• 1-2 years' experience as a medical claims processor, meeting or exceeding production and quality standards.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
• Knowledge of CPT, HCPCS, ICD-10 and revenue codes.
• Knowledge of CMS1500 and UB04 forms and fields.
• Experience with processing Medi-Cal or Medicaid program claims preferred.
• Experience in RAM HealthSuite a plus.
• Ability to work in cooperation with others.
• Ability to communicate effectively, both verbally and in writing.
• Ability to handle multiple projects simultaneously and balance priorities.
• Experience in the use of Microsoft Office software (Outlook, Word, Excel).
SALARY RANGE $29.10-$43.65 PER HOUR
The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.
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