Job Description :
Role: Healthcare Claims Processors
Location: Phoenix AZ

Seeking candidates with experience in Claims Processing. Professionals with healthcare background preferred. Training will be provided (2 - 3 weeks

Purpose:
Processing basic payments and/or claim denials for group health which includes medical, dental, vision, FSA, HSA, HRA and disability benefits; demonstrating the highest levels of customer service, technical skills and professionalism.

Essential Functions:
Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
Approving, pending, or denying payment according to the accepted coverage guidelines.
Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
Processing complex claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
Approving, pending, or denying payment according to the accepted coverage guidelines.
Knowledge of HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification, provider verification and preauthorization desirable.

Essential Skills:

Critical thinking
Time Management
Work Independantly
Effective Communicator
Strong attention to detail
Technical aptitude
Analytical

Qualifications:

High School diploma or GED required
2-3 years Claims processing or directly related work experience.
Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.
Must have FACETS exp OR ABS exp
Must have Medicare knowledge
Excel exp

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