Insurance Claims Processor-Peak Health

WVU Medicine

13h

About The Position

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. This position will report to the Claims Manager, playing a unique and important role in our mission to change healthcare for the better. Experience in the healthcare industry and critical thinking skills will help the organization build an effective and efficient claims team. The claims team will review and oversee the adjudication of claims ranging from the simple data entry to complex specialty claim research. The Claims Team will analyze and process insurance claims, checking for validity. Ability to determine whether to return, deny, or pay claims while following organizational policies and procedures is a must. This job screens, reviews, evaluate online entry, error correction, and quality control for final adjudication of paper/electronic claims.

Requirements

• High School diploma/GED
• One (1) year of experience working with medical or institutional claim data entry OR One (1) year of customer service experience.
• Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Ability to use mathematics to adjudicate claims
• Requires the ability to understand medical insurance requirements for payment and basic knowledge of covered services.
• Requires attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
• Ability to sit for extended periods of time.
• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC

Nice To Haves

• Associate Degree in related healthcare field.
• Two plus years of medical or institutional claims processing and customer service experience.
• Knowledge and understanding of medical terminology, third party payors and insurance preferred.

Responsibilities

• Determines accuracy and completions of claim information. Entry/verifies claims data.
• Resolves claim edits, review history records, and determine benefit eligibility for service.
• Reviews payment levels to arrive at final payment determination.
• Meets all production and quality standards, maintaining workques according to department standards.
• Effectively communicates with internal and external staff.
• Elevates issues to next level of supervision, as appropriate.
• Ensures accuracy of data entered and record maintenance.
• Attends all required training classes, demonstrating proficiency and ability to learn.
• Other duties as deemed appropriate by the Claims Manager.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees