To research and resolve provider telephone and written inquiries within established timeframes, accurately screen claims, and participate in provider meetings and projects. Support for either escalated calls or to accept calls of a more complex nature requiring additional skills. To provide support to CSR staff when call volume requires additional personnel. Routinely process CIFs as part of their daily workload.
SECONDARY DUTIES AND RESPONSIBILITIES
Education and Experience
High school diploma or equivalent. Minimum one (1) year of prior claims processing experience in an automated claim environment; or equivalent combination of education and experience.
Special Skills, Licenses and Certifications
Knowledge of CPT, HCPC procedure coding, and ICD-9 diagnostic coding. Knowledge of medical terminology. Ability to access coding reference guides for accurate information. Typing speed 30 wpm and proficient use of 10-key calculator.
Performance Based Competencies
Effective written and oral communication skills. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Good organization skills. Ability to accurately complete tasks within established times.
Work Environment And Physical Demands
Ability to use a computer keyboard. More than 80% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 5 lbs.
All HealthPlan employees are expected to:
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.