Medical Claims Specialist

ROCKY MOUNTAIN HEALTH CARE SERVICES•Colorado Springs, CO

2d•Onsite

About The Position

Medical Claims Processors are responsible for processing, adjudicating, and paying all program participant medical insurance claims including performing the daily customer service activities surrounding the claims process. Our mission is to improve lives, optimize wellness, and promote independence.

Requirements

High school diploma or equivalent required.
Minimum 3 years health insurance claims processing required.
Working knowledge of Medicare/Medicaid 1500 and UB claims preferred.
Accounts payable experience highly desirable.
Strong written and verbal communication skills.

Responsibilities

Processes provider claims including validation, coding, data entry, adjudication, and importing/exporting in claims management systems.
The standard rate of processing claims is 20 1500s and 8 UBs per day and prior months claims are to be entered and adjudicated by the second business day of the month.
Prepares and disburses payment checks with explanation of payments (EOPs) to providers.
Performs in depth analysis of complex claims identifying missing and/or incomplete data to determine appropriate resolution.
Acts as the primary contact for support and resolution with internal departments, program participants as well as external provider representatives for questions about claim status, appeals, etc.
Assists with research, development, implementation, and documentation of processes including identifying process gaps or issues along with appropriate solutions and inputs those processes into the departmental book of business as requested.
Other duties as assigned.