Claims Coordinator

Machinify

3d•Hybrid

About The Position

The Claims Coordinator handles the accurate and timely processing of healthcare claims. This role reviews notifications, checks documents for completeness, sets up claims in the system, and routes them to the right departments. The coordinator escalates problem claims, communicates missing information, and follows HIPAA and security standards to support a smooth claims review process.

Requirements

Minimum typing speed of 40 WPM
Strong data entry skills with a high degree of accuracy
Intermediate to advanced computer proficiency, including Microsoft Office Suite, Adobe Acrobat, working across multiple monitors, and the ability to quickly learn company-specific software
Exceptional attention to detail, with strong organizational, analytical, and critical thinking skills
Strong interpersonal and team-building skills, with the ability to collaborate across a diverse team and drive change across functional and business boundaries

Responsibilities

Monitor incoming claim notifications and ensure all required documents are complete and legible.
Verifying all required submission documents are present and legible.
Perform initial claim setup, accurately enter data, and assign correct claim statuses.
Perform initial analysis of data and documents submitted by the client such as claims, EOBs, bills, policies, correspondence, etc.
Combine and Extract claim documents when needed.
Copy combined file and rename according to policy and procedures.
Enter UB04 data information for analyst.
Transfer claim documents to Document Management and IBR departments.
Create appeal letters and return to client.
Analyzes the client provided coversheet for correct reimbursement.
Adjust system to reflect the correct reimbursement and savings.
Escalate claims with problems to Lead of claim processing.
Notify Lead of Claim Coordinator when documents are missing or illegible.
Maintain compliance with HIPAA and other security requirements.
Performs other duties as assigned.