Job Responsibilities : Medical Claims Processor-Work From Home
Salary : $18 per hour
Company : Presbyterian Healthcare Services
Location : Remote US
Educational requirements : High School
Competencies and skills:
- SKILL-Ability to effectively interact with customers to understand their needs and explain data
- SKILL-Microsoft Office
- Planning and coordinating organizational change
- Anticipating & Addressing Customer Needs
- Functioning as an Effective Contingent Member
- Acquiring & Applying Superior Skills to achieve Quality Outcomes
- Functioning as an Effective Team Member
- SKILL-Demonstrated ability to communicate effectively in person and via telephone with members employer groups brokers physicians and physician office staff using strong dialogue and customer service competencies.
- SKILL-Written communication
- Processes and adjusts inpatient and outpatient medical claims according to departmental quality and production standards.
- Pends claims as directed by departmental policies and procedures follows up for resolution and processes pended claims immediately following a benefit/payment determination.
- Identifies patterns in resubmitted and adjusted claims. Identifies errors and inconsistencies that require revisions to claim guidelines or system modifications
- Ability to process claims requiring special handling (i.e. Case Management Transplants Negotiations and processes coordination of benefits (COB) as required.
- Uses online policies and procedures to ensure accurate and consistent processing of claims.
- Performs follow up and takes all necessary actions required to resolve all errors and findings assessed by the Internal Audit department.