Senior Health Care Claims Processor
A Senior Health Care Claims Processor is responsible for reviewing, analyzing, documenting, and creating audit reports within time and quality assurance standards.
Forensic Review
- Complete forensic reviews, including identifying and/or researching new exceptions and arguments, and compile documentation to support exceptions
- Prepare Forensic Review, and facility reports on assigned claims
- Release reports to client liaison staff with appropriate communication
- Perform research as assigned
- Interact with clients and consultants as requested
- Maintain up-to-date documentation on all claims in HANDS system according to company standards
- Meet time, quality, and customer satisfaction standards
- Assist Pre-screen Specialist on complex pre-screens as needed
Other
- Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
- Contribute to department Wiki development
- 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 preferred
- Medical bill coding certifications helpful
- Insurance/claims experience preferred
Experience
- 3-5 years of experience in medical billing/coding, or claims review
- Familiarity with medical terminology helpful
Skills
- Advanced computer skills, specifically Excel
- Strong organizational skills and attention to detail
- Ability to multi-task and work with little direction
- Good verbal and written communication skills
- Team player demonstrating enthusiasm and commitment to company vision and mission
