Health Care Claims Processor
A Health Care Claims Processor is responsible for initial review and processing of claim referrals, including completing the initial pre-screen report and providing administrative support to the department.
Referral/Pre-Screen Processing
- Review all incoming claim referrals for completeness and legibility, coordinating with client relations and sales to obtain additional information
- Evaluate referral data against pre-screen criteria and review denials with director of ClinAssist operations
- Upload claim data to vendor for processing; review incoming data for accuracy
- Complete a level one review, including creating levels of care tables and reviewing levels of care and exception detail
- Work with quality assurance specialist to identify and correct quality issues
- Prepare final Pre-Screen Forensic Review, and Facility Reports on assigned claims
- Follow-up w/facilities to obtain information needed to process claims
- Maintain up-to-date documentation on all claims in HANDS system according to company standards
- Meet time, quality, and customer satisfaction standards
Department Administration
- Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
- Perform research as assigned
- Contribute to department Wiki development
- Receive and review various communications, including fax and e-mail, directing communications to appropriate personnel
- Interact with clients and consultants as requested
- Provide department and cross-department phone coverage
- Participate in department and company meetings as requested
- Complete special projects as assigned
Qualifications
Education and Certifications
- Bachelor's Degree or equivalent education or experience
- Medical Bill coding certification helpful
- Insurance/claims experience preferred
Experience
- 3+ years of administrative experience
- 2+ years of experience in medical billing/coding or claims processing
- Familiarity with medical terminology
Skills
- Advanced computer skills, specifically Excel
- Strong organizational skills and attention to detail
- Ability to multi-task and work with little direction
- Good communication skills
- Team player demonstrating enthusiasm and commitment to company vision and mission
