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Responsible for : Reviewing and researching insurance claims to determine possible payment accuracy. Validating Member, Provider and other Claims information. Determining accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordinating Claim Benefits based on the Policy & Procedure. Maintaining productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements.Requirements for this role include : 1+ years of Claims Adjudication experience to review claims rules and workflows is nice to have. 1+ years of experience processing claims that required a working knowledge of HCPCS, ICD and CPT codes is nice to have 1+ years of experience that required a knowledge of healthcare insurance policy concepts including In Network, Out of Network providers, Deductible, Coinsurance, Co-pay, Out of Pocket, Maximum inside limits and Exclusions, State Variations is nice to have. Regular working hours from 8:00 am to 5:00 pm (EST) Desired Skills: Prior experience with Xcelys and/or Amisys software system(s) is nice to have.Other similar customer service or claims processing experience will be preferred. Training will be provided.Please send your resume to: to apply.
Vacancy expired!