Associate, Claims Examiner
About The Position
Join MVP Health Care in shaping the future of health care by embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by curious, humble, and committed individuals dedicated to making a difference. For over 40 years, MVP Health Care has prioritized people, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in our customers, communities, and team. This role offers growth opportunities, a people-centric culture celebrating diverse perspectives, competitive compensation and benefits focused on well-being, and the chance to shape health care. You will contribute to our pursuit of excellence by bringing curiosity, humility, and a commitment to making a difference for our customers.
Requirements
- High School Diploma required.
- Previous related health care experience required
- Strong PC skills required, Microsoft Windows experience highly desired.
- Strong attention to detail.
- Curiosity to foster innovation and pave the way for growth
- Humility to play as a team
- Commitment to being the difference for our customers in every interaction
Nice To Haves
- Associate degree in health, Business or related field preferred
- Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred.
- Knowledge of Facets and Macess systems strongly preferred, but not required.
Responsibilities
- Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems.
- Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible.
- Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information.
- Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination.
- Meets or exceeds department quality and work management standards for claims adjudication.
- Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy.
- Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments.
- Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback.
- Keeps abreast of all benefit changes.
- Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Benefits
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
