Community Health System-posted 3 months ago
Full-time • Entry Level
Fort Wayne, IN
5,001-10,000 employees
Hospitals

The Claims Processor is responsible for accurately and efficiently processing healthcare claims submitted to third-party payors. This role ensures that claims are reviewed, submitted, and followed up on in accordance with regulatory requirements, payer policies, and organizational standards. The Claims Processor supports the revenue cycle process by identifying and resolving claim errors, submitting adjustments, and communicating with insurance payors to facilitate timely reimbursement.

  • Reviews claims for completeness, accuracy, and compliance with legal, regulatory, and payer-specific requirements.
  • Submits claims to third-party payors through manual and electronic processes in accordance with established timelines.
  • Tracks and documents all claim-related activity in the appropriate systems following standard workflow procedures.
  • Prepares and processes account adjustment requests in accordance with departmental policies and guidelines.
  • Composes and submits Service Support Requests (SSRs) or other internal forms to facilitate claim resolution.
  • Contacts insurance payors to resolve claim rejections, denials, or discrepancies, ensuring timely follow-up and correction.
  • Performs other duties as assigned.
  • Complies with all policies and standards.
  • Associate Degree Accounting, Business or related area of study preferred
  • 1-2 years of experience in medical claims processing or healthcare billing preferred
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