Hospital Claims Processor V

Job Title

Responsibilities

Review hospital claims and determine action needed to resolve pended claims

Process and evaluate hospital claims manually or through claims work flow

Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies

Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures

Review, finalize and respond to call tracking tickets in a timely manner to provider inquires

Perform additional duties and special projects as assigned by management

Qualifications

High School Diploma or GED required, some College or Degree preferred

Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required

Basic keyboarding skills required

Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)

Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes

Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments

Able to work well independently and in a team environment

Ability to meet strict deadlines, work well under pressure and in a fast-paced environment

Must meet performance standards including attendance and punctuality