Medical Claims Processor Job at Colorado Springs, CO US Full Time

MISSION: Improving lives, Optimizing wellness, Promoting independence

COMPETENCIES:

• Attention to detail
• Customer focus
• Professional demeanor
• Time management
• Medicare/Medicaid claims processing

RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

• Processes provider claims including validation, coding, data entry, adjudication, and importing/exporting in claims management systems. The standard rate of manual processing of claims is 20 1500s and 8 UBs per hour and prior months claims are to be entered and adjudicated by the second business day of the month.
• Prepares and disburses payment checks with explanation of payments (EOPs) to providers.
• Performs in depth analysis of complex claims identifying missing and/or incomplete data to determine appropriate resolution
• Acts as the primary contact for support and resolution with internal departments, program participants as well as external provider representatives for questions about claim status, appeals, etc.
• Assists with research, development, implementation, and documentation of processes including identifying process gaps or issues along with appropriate solutions and inputs those processes into the departmental book of business as requested.
• Other duties as assigned.

ORGANIZATIONAL (CORE RATING FACTORS):

• Demonstrates support of the Companys Mission, Vision and Core Values
• Provides Exceptional Customer Service
• Ensures discretion with confidential information in accordance with HIPAA guidelines
• Supports a collaborative work environment including courteous, helpful and professional behavior
• Embraces Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts
• Adheres to and supports all Company policies and procedures
• Supports and practices safe work habits in accordance with policies and procedures
• Brings ideas, problems and concerns forward and participates in resolution and implementation
• Participates in and completes regulatory compliance trainings within the prescribed deadlines
• Attends required meetings
• Maintains skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency

QUALIFICATIONS AND REQUIREMENTS:

• High school diploma or equivalent required.
• Minimum 3 years health insurance claims processing required. Working knowledge of Medicare/Medicaid 1500 and UB claims preferred.
• Accounts payable experience highly desirable.
• Strong written and verbal communication skills.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and working conditions described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical Requirements – Requires full range of body motion, manual and finger dexterity, and eye-hand coordination; requires the ability to use department equipment, to communicate effectively; requires standing, walking, sitting (possibly for long periods of time) and performing repetitive tasks (including working on the computer) for up to the entire work day; requires the ability to lift/carry up to 10 pounds using appropriate body mechanics.
• Visual, Hearing and Communication Requirements – Requires corrected vision and hearing to within normal range, with or without reasonable accommodation. Must be able to communicate effectively in verbal and written form with all levels of personnel within and outside of the organization.
• Pressure Factor – Requires working under stressful conditions. Moderate pressure to meet scheduled and recurring deadlines.
• Environmental Conditions Working in a closed office environment. Work space may be shared. Working conditions may be noisy with fluctuating indoor temperatures. May be exposed to a risk of bodily injury through contact with moving instrumentation, substances and other conditions common to an office environment.

REPORTS TO: Assistant Controller

SUPERVISES: N/A