Claims Processor II

MedImpact Healthcare Systems, Inc.•Honolulu, HI

6d•$18 - $28•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! The successful candidate will work as a member of the Claims Processing team, ensuring accurate and timely processing of Physician, Facility, Dental, and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans, and Minimal Essential Coverage (MEC) plans. Interprets schedules of benefits and plan documents to apply accurate benefits to claims according to the plan design. Applies internal policy and procedures for claims adjudication, identifies and resolves claim processing errors, adjusts previously processed claims, and logs refunds for claim overpayments. Performs data entry of CMS 1500, UB 04, and dental claims, research claim issues, and assists in audit projects. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform job functions, with supervision ranging from close to minimal oversight based on demonstrated skill and performance levels.

Requirements

GED/HS Diploma and 1+ year experience or equivalent combination of education and experience
Intermediate knowledge of MS Office/Word, Excel, PowerPoint and Outlook.
Experience with Windows based database programs is preferred.
Strong aptitude for new programs.
Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's.
Ability to perform these operations using units of American money and weight measurement, volume, and distance.
Ability to read and comprehend simple instructions, short correspondence, and memos.
Ability to write simple correspondence.
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Nice To Haves

Certified Claims Professional (CCP), Medical Billing and Coding Certificate, or Certified Professional Coder (CPC) not required but highly preferred.

Responsibilities

Accurate and timely processing of Physician, Facility, Dental and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans and Minimal Essential Coverage (MEC) plans.
Adhere to Corporate and Departmental standards including production and quality goals.
Interpret schedule of benefits and plan documents to apply accurate benefits to claims according to the plan design.
Identify potential system or plan design issues that would impact the correct adjudication of a claim.
Effectively communicate with the Management team on claim processing questions and issues.
Interpretation and application of internal policy and procedures for claims adjudication.
Identify and resolve the root cause of a claim processing and/or data entry error.
Adjust previously processed claims.
Identify claim over payments and log refunds.
Data entry of CMS 1500, UB 04, and dental claims.
Research complex claim issues.
Assist in audit projects