Claims Mailroom Clerk

Summary Description The Claims Department is responsible for receiving, validating, and processing payment to providers and members. The Claims Mailroom Clerk will oversee incoming and outgoing mail, track current processing times, returns, payments, and claim statuses to report issues to the Claims Department.

Key Tasks and Responsibilities

· Open all paper claims and member reimbursement logs received via mail, emails, faxes, and logs.

· Sort, batch, and date stamp.

· Scan and upload documents into respective folders in SharePoint.

· File the claims into their respective folder for audit purposes.

· Place unopened or opened claims placed in designated area for Medical Claims Processor access.

· Print and mail Claims Acknowledgement letter to providers.

· Print and mail return letter to providers with rejection reason.

· Track and log returns, provider disputes and member inquiries.

· Send member reimbursement log and update tracking log.

· Track claims, payment, and rejections.

· Identify missing or invalid claims data.

Education & Training

· Required: High School Diploma or GED

· Preferred: 1-2 years' experience in office setting, preferably in a Claims environment.

Knowledge and Experience

· Knowledge of CMS 1500 forms and fields.

· Knowledge of required transportation HCPCS codes, modifiers, provider Medicaid ID, TIN and NPI.

· Knowledge of state Medicare and Medicaid program guidelines and requirements.

· Experience as a support clerk

· Accurate data entry

· Excel and Word knowledge

Core Competencies

· Strong organizational skills

· Ability to communicate efficiently with multiple areas of the organization

· Strong written and verbal communication skills

· Track claims, payment, and rejections

· Ability to multi-task with frequent interruptions

· Exceptional attention to detail and accuracy

· Identify missing or invalid claims data

· Abide to deadlines

· Excellent time management skills

· Exceptional attendance and timeliness

Working Conditions

· This is a pull time onsite hourly position.

· No travel is required.

Physical Requirements

· This position requires working on a sitting position working on a computer and operating a keyboard and a mouse as well as other office equipment like phones and printers and filing documents.

Secure Transportation is an Affirmative Action/EEO employer.