Claims Process Executive (remote)

Cognizant Technology Solutions • Phoenix, AZ

287d • $17 - $20 • Remote

About The Position

Claim processors will review claim submissions, verify information, adjudicate the claim as per claim processing guidelines to ensure appropriate payment or denial as per the business requirements.

Requirements

• High School diploma or GED required
• Minimum of two-three years of Medicaid and or Commercial claims payer processing experience
• Ability to work independently
• Strong attention to detail
• Strong interpersonal, time management and organizational skills
• Good oral/written communication and analytical skills
• Must be able to work in a high-performance environment that changes often
• Experience in navigating multiple systems using dual monitors
• Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required
• FACETS experience (highly preferred)
• Medicaid knowledge (required)
• Keyboard skills of at least 35 WPM + 10-key
• Proficient in Microsoft Office - Excel, Word, and Outlook
• Healthcare claims payer processing experience (required)
• Ability to work at a high pace while maintaining quality and productivity targets

Responsibilities

• Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met
• Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit
• Approving, pending, or denying payment according to the accepted coverage guidelines
• Follows all team procedures, including HIPAA policies and procedures, and meets team quality, turnaround time and productivity performance standards and goals
• Identifying and referring all claims with potential third-party liability (i.e., subrogation, COB, MVA, stop loss claims, and potential stop loss files)
• Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file with regard to claims status, questions or claim payments
• Other duties as assigned
• Must be willing to work overtime when the business need requires

Benefits

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: High school or GED