Claims Examiner I (Remote, $15/hour)

American Specialty Health Incorporated

13d•$15•Remote

About The Position

American Specialty Health Incorporated (ASH) is seeking an Examiner I to join our Claims department. The primary purpose of this position is to verify claim information lifted from the CMS 1500 form by Optical Character Recognition and enter data from CMS 1500 Claim Forms into the Claims Processing System, and to process claim edits from electronic claims. This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization. Remote Worker Guidelines Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network. The internet connection must have a consistent 50 down/10 up Mbps minimum internet speed. 100 down/20 up is recommended to support higher quality video meetings.

Requirements

High School Diploma or GED certificate required.
6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.
Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
Proficient in MS Office.
Ability to work and maintain production in a work-from-home (WFH) environment.
Demonstrated ability to show self-discipline to meet production goals.

Nice To Haves

Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.

Responsibilities

Processes claims accurately and efficiently.
Reviews all incoming claims to verify necessary information.
Determines that correct member and provider records are chosen and utilized to process claims.
Enters claims data and information into the computerized Claims Processing System.
Maintains all required documentation of claims processed and claims on hand.
Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.
Verifies data of scanned paper claims at stated standards.
Provides backup for other examiners within the department.
Promotes a spirit of cooperation and understanding among all personnel.
Attends organizational meetings as required.
Adheres to organizational policies and procedures.
Maintains confidentiality of all claim files, claims reports, and claims related issues.
Performs other duties as assigned.
Complies with all policies and standards.