Claims Processor
Posted on :
18-11-2022
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Job Description
Job title: Claims Processor
- Job Location: 6200 Greenwich Drive, San Diego, CA 92122
- Shift - 6am - 2:30pm, M-F
Job Description
"Teleflex" work arrangements available following completion of training, which means most of the time the employee can work remotely, but needs to physically be in the region to be able to come on site if/when a business needs arise.
SHIFT: 40H FT, M-F 6am-2:30pm
JOB DESCRIPTION:
Process complex claims for all lines of business. Process and understand COB adjudication. Understand and investigate
TPL claims. Finalize fatal electronic interface claims. Initial and ongoing training of Claims Department staff. Assist in
system upgrades and implementation of new or revised software related to claims adjudication. Special projects as
assigned. Extensive knowledge of Epic AP Claims, CPT, ICD, ASA and HCPCS coding. Extensive knowledge of AWP
calculation. Must have 95% audit results. Must have 5+ years claims experience. Must have production average of 15
claims per hour. Job standards to be performed at the EXPERT level.
REQUIRED QUALIFICATIONS:
Minimum 5 years relevant experience.
Expert knowledge of current HMO claim processing protocols and regulatory guidelines. Extensive knowledge of CPT, ICD, ASA and HCPCS coding as pertains to claim adjudication. Proficiency with MS Word, MS Excel, MS Outlook, and Internet Explorer.
High school diploma or equivalent.
PREFERRED QUALIFICATIONS:
Experience with Epic AP Claims claim processing system.
Healthcare environment experience.
4-year college degree
Employment Type
Full Time
Key Skills
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