Remote Claims Data Entry Specialist Jobs | Medical Claims Processor Jobs Work From Home

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.