Processor III
: Job Details :

Responsibilities

• Examine medical claims for completeness of information
• Number claims sequentially if necessary
• Data enter claims in the claims processing system (QNXT) based on information given by the provider, verify eligibility in Vi-Tech system
• Process Medicare Part B, Medicaid, Vision, Hearing Aid and Speed Claims (as necessary)
• Manually price claims when required, resolution of claim edits
• Enter appropriate International Classification of Diseases (ICD), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes, or other local codes and provider identification number.
• Apply contractual benefits, medical policy and operational procedures to resolve medical claims
• Coordinate benefits with other insurance carriers
• Record claim finalization status and save in Document Management System (DMS)
• Return finalized medical claims and incomplete claims with transmittal sheets to designated control stations
• Perform additional duties as assigned by management

Qualifications

• High School Diploma or GED required, some college or degree preferred
• Minimum two (2) years medical claims processing experience in a health insurance or benefits environment required
• Excellent keyboarding skills required (minimum 6,000 kph and 6% or less error rate)
• Knowledge of medical benefits and eligibility systems
• Knowledge of ICD, CPT, and HCPCS codes
• Ability to work well under pressure