Claims Processor (52219)

GLOBALHEALTH HOLDINGS LLC • Oklahoma City, OK

3d • Remote

About The Position

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer seeking to be the employer of choice by attracting and retaining a talented workforce. We are passionate about providing Genuine Care and Optimal Health to our members through high-touch, high-value, and partnership-based services. We offer affordable health insurance with desired benefits and aim to be long-term partners with our members. We value accountability, ownership, drive, innovation, and a passion for continuous learning.

Requirements

• High school diploma or equivalent required.
• Must have full understanding of insurance processes (Managed Care, Medicare, Medicaid and Commercial practices).
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of Medicare and Health Care Finance Administration regulations.
• Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs and authorizations/referrals.
• Ability to read and interpret provider contracts.
• Strong verbal, written and organizational skills, must be self-directed/self-motivated and must have analytical, problem-solving, and decision-making abilities.
• Accurate keyboard skills.
• Ability to function in a fast-paced, detail-oriented environment.
• Basic math skills.
• High degree of accuracy.
• Team player.

Nice To Haves

• Two year of medical claims processing experience strongly preferred.

Responsibilities

• Processes claims based on the productivity and quality standard set (HCFA1500 and UB92) per day in accordance with contractual and non-contractual agreements and processing guidelines.
• Works with Claims Supervisor or Manager in review of processed and pended claims to ensure appropriate, timely and accurate claims processing.
• Coordinates with Claims Manager on resolution of customer service inquiries within 24 hours of receipt.
• Assist with Claims adjustment projects as requested.
• May help with Claims entry when requested.
• Completes various work assignments as requested by supervisor in a timely manner.
• Maintains current desk procedures and reference materials.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED