Technical Information Specialist
About The Position
Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes. This is a detail-oriented, clerical support position serving the medical review team. This position is full time (40 hours/week) Monday-Friday 8:00-4:30 and will be onsite. This is computer-based work; phone contact is minimal and limited to returned-mail situations only. Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments. Investigates and analyzes adjustment claim history and denial records. Prescreens records for review and maintains accurate records of all claims. Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials. Performs quality control of work processes. Assists manager with special projects.
Requirements
- Associate's Degree Equivalency: 2 years job related work experience
- 1 year administrative/clerical support
- Working knowledge of word processing software
- Strong analytical, organizational, and customer service skills
- Strong verbal and written communication skills
- Proficiency in spelling, punctuation, and grammar skills
- Good judgment skills
- Ability to handle confidential or sensitive information with discretion
- Microsoft Office
Nice To Haves
- FISS Experience
- Medicare experience
- Claims knowledge
Responsibilities
- Maintenance of records
- Processing of claims in medical review
- Processes ingoing/outgoing mail
- Prepares work for nursing staff
- Troubleshoots claims prior to nurse review and after review
- Monitors timeliness of claims processing
- Adjusts claims keyed incorrectly
- Performs quality control of work processes
- Processes denials of claims
- Processes adjustment claims for both pre-pay and post-pay departments
- Investigates and analyzes adjustment claim history and denial records
- Prescreens records for review
- Maintains accurate records of all claims
- Communicates with provider community
- Assists provider service department in responding to inquiries
- Generates educational correspondence to providers regarding denials
- Assists manager with special projects
Benefits
- 401(k) retirement savings plan with company match
- Subsidized health plans
- Free vision coverage
- Life insurance
- Paid annual leave
- Nine paid holidays
- Wellness programs
- Healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Incentive Plan
- Merit Plan
- Continuing education funds for additional certifications and certification renewal
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
