Responsible for the accurate processing and completion of claims upon first receipt.
Process basic types of claims within current turnaround standards.
Responsible for applying correct pricing mechanism to claims.
Reviews and monitors pended claims reports as applicable and appropriate.
Process adjustment requests.
Ability to understand and apply health plan concepts to include: contract language, benefit interpretation, COB, multiple surgery reduction, bilateral surgery pricing, co-insurance, out of pocket/lifetime maximums.
Refers claims review requests that require professional medical necessity to nurse or Medical Director for review and determination in an appropriate and consistent manner.
Documents applicable information to support claims determinations.
Generate member and provider communications as needed.
Must meet productivity goals of processing a minimum 150 to 180 claims per day with no more than a 2% error rate
Minimum one to two years’ prior experience examining claims in an automated healthcare setting; or equivalent combination of education and experience.
Please apply at:
OnDemand Employment Group
2011 Auto Center Drive #116
Please bring with you 2 (two) forms of valid identification and an updated resume.