Description:
To adjudicate medical claims for payment in an accurate, timely, and efficient manner.
Essential Position Functions
- Process claims for payment on assigned accounts from aged report, adjudication queue, and internal and external requests.
- Assure claims are paid accordingly based on fee schedule, contract, group policy, and provider.
- Review written correspondence and medical notes to assure claims are paid accurately.
- Meet or exceed all Key Performance Indicator (KPI) quality and production goals.
- Reprocess claims as necessary.
- Answer claims questions from other departments.
- Identify and communicate system issues, billing patterns, training opportunities, etc. to the claims supervisor.
- Comply with all company policies and procedures.
Minimum Requirements of the Position
- High school graduate or equivalent.
- Prior claims processing experience preferred.
- 10 key proficient.
- Basic proficiency in Microsoft Word and Excel.
- Medical terminology and a basic understanding of ICD-10CM, HCPCS and CPT coding is helpful.
- Ability to work in a team environment.