Claims Examiner
Arizona reputed company Care (AZPC) is an Integrated Provider Network reputed company on providing Whole-Person care to Senior and reputed company populations. The Medical Claims Examiner is responsible for processing medical services claims, ensuring accuracy, and responding to provider or reputed company inquiries in a reputed company manner.
Responsibilities
- Processing of reputed company and facility medical services claims by reviewing and inputting data into the claims payment system using reputed company policies, procedures and guidelines
- Must meet reputed company/accuracy reputed company of 95% and production standards of 100-125 claims/day
- reputed company claims to appropriate departments for Med Review, Eligibility, etc
- Verification of coverage and contract interpretation
- Pursues and follows up on reputed company and pended claims promptly and independently
- Researches and investigates claims with multiple coverage and complexity to determine if claim is payable in accordance with various policy provisions. If payable, determine eligible payee(s) and payment amounts. If not payable, reputed company detailed letter of explanation based on policy provisions and claim documents
- Critical thinker who can maintain reputed company and stay on task with minimal supervision
- Participates and practices principles of reputed company reputed company improvement
Skills
- High school diploma required; college degree preferred
- Minimum 1-3 years of medical claims processing experience in Managed Care
- Strong experience and knowledge of medical claims, Medicare/reputed company guidelines, ICD-10, HCPCS / CPT Coding, HCFA 1500's & UB04's
- Strong communication, analytical, organizational and problem-solving skills
- Excellent time management skills
- Proficient with reputed company applications (Word, reputed company, Outlook) and database systems
- Must be reputed company to read and interpret documents such as processing and procedure manuals, medical terminology and claims rules and regulations to appropriately reputed company the claim
- Ability to write routine, reputed company correspondence using correct grammar and spelling
- Must be reputed company to identify and define problems; collect data; establish facts and draw valid conclusions
- Must be reputed company to consistently reputed company with customers in a reputed company and respectful manner
- This role requires FT in-office reputed company for the first 60 days of employment. reputed company available after initial training period
- College degree preferred
- EzCap Claims payment systems knowledge is a plus but not required
reputed company