Claims Processor

Hybrid/Remote Work - Training will be completed onsite and hybrid work schedule coordinated with department supervisor.

Candidate will complete a phone interview prior to offer.

Job Duties and Responsibilities:
Responsible for efficiency standards for number claims completed and for accuracy of entries
Handles in a professional and confidential manner all correspondence
Supports core values, policies, and procedures
Obtains and adjudicates medical claims for processing; reviews scanned, EDI, or manual documents for pertinent data on claim for complete and accurate information.
Acquires daily workflow via reports or work queue and incoming phone calls
Research claims for appropriate support documents
Analyzes and adjusts data, figures out appropriate codes, fees and ensures timely filing and contract rates are applied
Responds and documents resolution of inquiries from internal departments
Assists Finance with researching provider information to resolve outstanding or stale dated check issues
Performs Provider Dispute Request (PDR) fulfillment process from the point of claim review through letter processing and records outcome in applicable tracking databases


Education:
High school diploma/GED required. Bachelor's degree in healthcare or related field preferred.

Experience:
Three (3) years of medical claims processing for Medicare and Commercial products and provider dispute resolution processing in an IPA, HMO and Hospital related setting required. Three (3) years of experience with processing all types of specialty claims such as Chemotherapy, Dialysis, OB and drug and multiple surgery claims required. Three (3) years of experience on an automated claims processing system (Epic Tapestry preferred) preferred.