To research and resolve provider telephone and written inquiries within established time frames, accurately screen claims, and participate in provider meetings and projects. To accurately research and process paper and electronic medical, outpatient, ancillary, long term care, CHDP, encounter data and paper crossover/other coverage claims within established time frames, applying appropriate program policies related to claims processing and analysis.
Education and Experience
High school diploma or equivalent; one (1) year of prior claims processing experience in an automated claim environment preferred; or equivalent combination of education and experience.
Special Skills, Licenses and Certifications
Knowledge of CPT, HCPC procedure coding, and ICD-10 diagnostic coding. Knowledge of medical terminology preferred. Ability to access coding reference guides for accurate information. Typing speed 30 wpm and proficient use of 10-key calculator.
Performance Based Competencies
Excellent written and oral communication skills. Ability to effectively exercise good judgment within scope of authority and handle sensitive issues with tact and diplomacy. Good organizational skills. Ability to accurately complete tasks within established time frames.
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 25 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 or definitive 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.