Medical Claims Specialist

ROCKY MOUNTAIN HEALTH CARE SERVICES•Colorado Springs, CO

11d•$21 - $24•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. MISSION: Improving lives, Optimizing wellness, Promoting independence

Requirements

High school diploma or equivalent required
Minimum 3 years health insurance claims processing required.
Strong written and verbal communication skills

Nice To Haves

Working knowledge of Medicare/Medicaid 1500 and UB claims preferred
Accounts payable experience highly desirable

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
Demonstrates support of the Companys Mission, Vision and Core Values
Provides Exceptional Customer Service
Ensures discretion with confidential information in accordance with HIPAA guidelines
Supports a collaborative work environment including courteous, helpful and professional behavior
Embraces Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts
Adheres to and supports all Company policies and procedures
Supports and practices safe work habits in accordance with policies and procedures
Brings ideas, problems and concerns forward and participates in resolution and implementation
Participates in and completes regulatory compliance trainings within the prescribed deadlines
Attends required meetings
Maintains skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency