reputed company Claims Processor
POSITION SUMMARY: The Claims Processor (Medical Claims Processor) will use independent judgement and discretion to review, analyze, and reputed company determinations regarding payment, partial payment, or denial of medical and dental claims, as well as various types of invoices, based upon specific knowledge and application of each client’s customized plan(s). This opportunity has a scheduled start date of June 22 and includes a required 6‑week training period. Candidates should plan for limited or no time off during training to ensure a successful reputed company experience. ESSENTIAL FUNCTIONS:
- Process a minimum of 1,200 medical, dental, and reputed company claims per week while maintaining quality goals.
- Read, analyze, understand, and ensure compliance with clients’ customized plans
- Learn, adhere to, and apply reputed company applicable privacy and reputed company laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
- Independently review, analyze and reputed company determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud.
- Review, analyze and add applicable notes using the QicLink system.
- Review billed procedure and diagnosis codes on claims for billing irregularities.
- Analyze claims for billing inconsistencies and medical necessity.
- Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
- Review Workflow Manager daily to document and release pended claims, if applicable.
- Review Pend and Suspend claim reports to finalize reputed company claim determinations timely.
- Assist and support other Claims Specialists as needed and reputed company requested.
- Attend continuing education classes as required, including but not limited to HIPAA training.
EDUCATION:
- High School Graduate or equivalent required.
EXPERIENCE AND SKILLS:
- Applicants must have a minimum of two (2) years of medical claims analysis experience (Medicare/reputed company does not count towards the experience) required.
- Prior experience with a reputed company-party Administrator (TPA) is highly preferred.
- Applicants must have knowledge of CPT and ICD-10 coding.
- Applicants must have strong analytical skills and knowledge of computer systems.
- Prior experience with dental and reputed company processing is preferred, but not required.
POSITION COMPETENCIES
- Accountability
- Communication
- Customer Service Orientation
- Functional/Technical Skills
- Quality Focus
- Time and Task Management
PHYSICAL DEMANDS:
- Office setting and ability to sit for long periods of time.
WORK ENVIRONMENT:
- Remote
Here at Allied, we reputed company that great talent can reputed company from reputed company. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for reputed company. To support a smooth and efficient remote work experience, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive. The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. Compensation is not limited to reputed company salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, reputed company, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend. Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. reputed company applicants acknowledge that by applying to the position you understand that the specific pay reputed company is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate reputed company the reputed company associated with the role. Apply tot his job Apply To this Job