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Senior Claims Processor

2 months ago

Honolulu, Hawaii, United States University Health Alliance Full time
Job Title: Senior Claims Processor

Job Summary:

We are seeking a highly skilled Senior Claims Processor to join our team at University Health Alliance. As a Senior Claims Processor, you will be responsible for processing and adjudicating medical claims in a timely and accurate manner.

Key Responsibilities:

  • Process and adjudicate medical claims, including provider claims, outpatient claims, and inpatient claims.
  • Assist in training staff and compiling daily workflow reports to ensure efficient claim processing.
  • Track claims inventory and system tests to ensure accuracy and compliance.
  • Process complex and special handle claims, including Member Cost Transparency Notices (MCTN) and Letter Of Agreement (LOA) cases.
  • Prepare and process High-Cost Inpatient claims and Third Party Liability (TPL) cases.
  • Coordinate processes with Out of State Participating Provider Network.
  • Process HCFA 1500, Prescription Drug claims, EDI, and UB04 claims.
  • Data entry and review of outsourced rejected claims.
  • Assist with review and processing of special handle claims, analyzing and calculating coordination of benefit payments.

Requirements:

  • High School Diploma or equivalent.
  • Three years of medical claims filing and processing experience, with at least one year of experience with UHA's claims processing system.
  • Proficient in medical terminology, medical billing, medical coding, Anatomy and Physiology.
  • Able to interpret group benefit plan coverages.
  • Thorough knowledge of medical claims and drug claims processing software applications.

Preferred Qualifications:

  • Associate Degree.
  • CPC (Certified Professional Coder).
  • HIPAA Privacy and Security.
  • URAC standards as applicable to the job.

Working Conditions:

The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job.

  • Frequent sitting, talking, hearing, and use of a computer keyboard and monitor, reaching, bending, standing, and walking.
  • Occasional climbing, stooping, kneeling, crawling, and crouching.
  • Occasionally required to lift, move, and/or carry up to 10 pounds.

This position is eligible to work from home upon management's approval.

Competitive compensation and excellent benefits offered.