Job Description :

· High School degree or GED required; experience with Third Party Administrators (TPA) and/or ERISA plans preferred.

· Five (5) years of experience with medical claims processing or medical billing

· Specific experience in handling claims adjustments

· Knowledge of medical billing procedures; ADA, CPT and ICD coding and medical terminology knowledge.

· Proficiency with data entry skills, PC skills, and MS Office skills (Word and Excel) required.

· Demonstrated consistent ability with independent decision making to include effective problem resolution.

· Analytical skills for review of health care delivery against established criteria while demonstrating strong attention to detail and follow through.

· Ability to meet or exceed all departmental goals to include accuracy and productivity.

· Excellent verbal, written and interpersonal communication skills required

· Ability to develop and maintain standard operating procedures, with demonstrated ability to utilize available resources without assistance.

Working Conditions

While performing the duties of this job, the associate is regularly required to communicate professionally, over the telephone, through email and other electronic means, handle various types of media and equipment, and visually or otherwise identify, observe and assess. Responsibilities occasionally may require an adjusted work schedule, overtime, and evening hours in order to meet deadlines.
This will be a large-scale project focused on Claims Adjustments
The work environment characteristics described above are representative of those an associate encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Maintains confidentiality and uses only the minimum amount of protected health information (PHI) necessary to accomplish job related responsibilities.
Other duties as needed. Every associate is given a job description upon hire outlining the qualifications, duties, and pay grade of the position. Nova reserves the right to change job descriptions as necessary.
Will adhere to all federal and state laws, rules and regulations, and Nova policies and procedures. Promote a professional and ethical environment through active engagement with Nova’s Compliance Program.

Key Accountabilities

Technical Proficiency:

Adjudicate claims based on established policies and procedures for facility, professional, pharmacy and dental claim edits.
This is inclusive for both in and out-of-network benefits.
Meet or exceed all department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication. Analyze, identify and research, as needed, edits which demonstrate inconsistency in