Medical Claims Examiner
4 weeks ago
ONSITE IN GREENVILLE, SC
Full Job Description
BSI Companies is seeking a highly energetic, self-motivated candidate with previous experience in a TPA or medical insurance background. This candidate must be detailed-oriented. The Claims Examiner is responsible for processing medical, dental, vision and Flexible Spending claims in accordance with CMS and the member plan benefits.
RESPONSIBILITIES:
Performs through review of pended claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services.
· Corrects system generated errors manually prior to final claims adjudication.
· Process claims based upon the provider’s contract/agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and BSI policies and procedures.
· Alerts manager or supervisor of more complex issues that arise.
· Processes claim exception reports as assigned
· Maintain required levels of production and quality standards as established by management.
· Attendance at employer worksite is an essential job requirement.
QUALIFICATIONS:
· Preferred minimum of one year experience in medical claims processing, third party administration or a self-pay claims processing system.
· Current working knowledge of ICD-10, CPT, ADA, revenue codes and all applicable bill types.
· Proficient with medical coding and terminology.
· Good verbal and written communication skills.
· Ability to work under pressure and adapt to changing environment.
· Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines.
· Proficient in Microsoft Office (Word, Excel, Outlook).
· Reliability and a strong work ethic are a must.
Job Type: Full-time
Schedule:
· 8 hour shift
Experience:
· Claims Processing: 1 year (Required)
Location: Greenville, SC (Required)
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