Medicaid Claims Processing, Associate, Claims Examiner

Mvp Health Plan Inc•Rochester, NY

46d•Remote

About The Position

Qualifications you'll bring: High School Diploma required. Associate degree in health, Business or related field preferred The availability to work Full-Time, Virtual within New York State Previous related health care experience required Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems. Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible. Knowledge of Facets and Macess systems strongly preferred, but not required. Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information. Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. Meets or exceeds department quality and work management standards for claims adjudication. Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy. Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments. Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback. Keeps abreast of all benefit changes. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you'll be: Virtual, Rochester or Schenectady, NY

Requirements

High School Diploma required.
The availability to work Full-Time, Virtual within New York State
Previous related health care experience required
Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail.
Curiosity to foster innovation and pave the way for growth
Humility to play as a team
Commitment to being the difference for our customers in every interaction

Nice To Haves

Associate degree in health, Business or related field preferred
Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred.
Knowledge of Facets and Macess systems strongly preferred, but not required.

Responsibilities

Using a PC /Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems.
Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible.
Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information.
Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination.
Meets or exceeds department quality and work management standards for claims adjudication.
Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy.
Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments.
Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback.
Keeps abreast of all benefit changes.
Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.