Claims Processor I

POSITION

Claims Processor I

Position Type : Temporary

Schedule : M-F, : am - : pm (Telecommute)

Assignment Length : Approximately -Months, possibly longer.

DESCRIPTION

Under the direction of the Provider Claims Resolution & Recovery Supervisor, the Claims Processor I - Provider Claims is responsible for the pre-processing of medical claims. This includes validating member coverage, clearing system edits and categorizing a claim type to ensure the claim routes to the appropriate workgroup for adjudication.

• Responsible for analyzing and processing claims EDI error queues prior to claim adjudication, correcting claim information and data integrity.
• Processes professional claims as assigned by Supervisor or Manager based upon the team member's knowledge, experience and billing and coding training.
• Prepare outgoing correspondence for the Claims Department including misdirected claims, additional information requests, and other mailings as needed.
• Interface with other Departments, when necessary, regarding claims issues.
• Participate in Claims Department staff meetings, and other activities as needed
• Responsible for meeting performance measurement standards for productivity and accuracy.
• Any other duties as required to ensure the company operations are successful.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in Company policies and procedures relating to HIPAA compliance.

REQUIREMENTS

Key Qualifications