Careers

Primary Responsibilities:

• Review claims for financial responsibility including determining coordination of benefits
• Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization
• Process claims appropriately per contract or standard processing guidelines which includes appropriate coding of CPT and ICD codes against charges that are being billed and entered
• Maintain prompt turnaround time on all claims and handle priority claims within 24 hours
• Handle all customer service audits and quality assurance errors/opportunities within 48 hours
• Coordinate with the Claims Manager and/or Claims Supervisor on workflow issues and the handling of batches in date order
• Document all claims production via the Claimscape® system
• Must meet and maintain 95% quality expectations; these are identified via errors tracked on phone calls, overpayments, unsolicited checks, appeals, TDI complaints and errors on processing by Audit Department
• Create and generate any overpayment documentation (notes in system, written communications) on all overpayments created by an analyst or any overpayments identified by analyst
• Must meet and maintain claims processing metrics daily
• Take ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
• Perform all other related duties as assigned