Reference Code: 879092-ONS
Description:
This person will be responsible for evaluating and reviewing claims received via Macess, EDI, and direct submission to determine accuracy of data submitted from providers and to identify system errors. This role will recommend modifications to improve efficiency and accuracy. Duties and Responsibilities:
· Correct coding, provider number, and member number submission errors to allow claims to be reloaded and processed for claims adjudication and payment
· Search for member and provider numbers using multiple software systems while correctly applying general rules for selection and exceptions to the same
· Adhere to strict turnaround times and deadlines
· Maintain Excel spreadsheet for claims received, corrected and reloaded recording dates and amounts
· Identify system flaws and recommend workflow and/or changes to improve accuracy and efficiency of system processing
· Elevate provider submission issues to management for provider education
Requirements:
The skills, experience, and knowledge required to be considered for this position include:
· A high school diploma or equivalent is required; 2 years of college is preferred
· Medical claims processing experience is required; knowledge of provider contracting is preferred
· Excellent oral and written communication skills
· Knowledge of medical claims processing
· Knowledgeable in MS Word and Excel
· Ability to analyze data to determine problems and suggest solutions
· Ability to work under pressure and manage a large workload
· Ability to adjust to changes in method, processes and procedures
· Ability to navigate multiple software applications simultaneously
· Ability to work independently and effectively under pressure
· Be assertive, self-directed, and resourceful