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Medicare Examiner II
3 months ago
Medicare Examiner II
Primary Duties & Responsibilities
Examiner supports the claim operation by completing a wide variety of tasks designed to gather and organize claim information for processing by claim examiners. Key functions of this role vary as business needs dictate, but often include such tasks as mail sorting and preparation, claim indexing, customer contacts and check processing tasks. Additionally, the examiner will backup the refund desk by processing refunds, voids and managing the Subrogation queues.
Primary Duties & Responsibilities
• Review correspondence and Explanation of Benefits (EOBs) to verify reason for returned check (i.e. refund or reissue)
• Process refunds due to overpayments and ensure monies are credited to the appropriate account/company
• Request additional information from provider required to accurately process refunds, as needed
• Route checks needing to be reissued to appropriate examiner for processing
• Identify non claim related checks and route to the appropriate business units (i.e. Unclaimed Property, Premium Accounting, Agency Services, etc.)
• Coordinate with General Accounting for verification of check status on void/stop payment requests
• Respond to incoming inquires received through various channels (i.e. Customer Service, faxes, email, etc.)
• Maintain and ensure security of file cabinet with refund checks and other correspondence
• Review daily On base reports to perform reconciliation of previous days refunds
• Meet or occasionally exceed established standards for productivity and quality and maintain claim turnaround time set with accuracy less than 2% error ratio.
• Mail sorting, send letters, claim indexing, customer contacts and check processing tasks
• Ensure all appropriate documentation , including any missing documentation is concise.
• Maintain LTC and Subrogation mailbox and responses.
• Attend and actively participate in departmental meetings, trainings and coaching sessions.
• Maintain patient privacy and confidentiality in accordance with HIPAA standards.
• All other duties as assigned or as a situation dictates.
Required Skills
Knowledge, Skills, & Abilities
• Ability to compile and review information to make sound decisions
• Skilled in performing intermediate arithmetic calculations
• Excellent typing skills
• Proficiency in Microsoft Office Suite (i.e. Outlook, Excel, Word) and other basic computer programs
• Ability to thrive in fast paced environment while working independently and with limited supervision
• Positive team oriented attitude with flexibility to adjust to changes as they arise
• Ability to multi-task
• High attention to detail and accuracy
• Working knowledge of Onbase, and Mainframe
Required Knowledge & Experience
- High School Education
- Health claims processing experience preferred
