[Hiring] Claims Processor @GLOBALHEALTH HOLDINGS LLC

Role Description

The Claims Processor is primarily responsible for processing all types of contracted and non-contracted claims accurately and timely for Medicare, Medicaid, and Commercial Insurance products. The Claims Processor works directly with the Team Leader and/or Claims Supervisor on the day-to-day operations of the Claims for the purpose of meeting the company, department, and regulatory standards for quantity, quality, and timeliness. This position requires the ability to work independently, accomplish goals, and possess excellent customer service and communication skills.

Essential Job Functions

• Processes claims based on the productivity and quality standard set (HCFA1500 and UB92) per day in accordance with contractual and non-contractual agreements and processing guidelines.
• Works with Claims Supervisor or Manager in review of processed and pended claims to ensure appropriate, timely, and accurate claims processing.
• Coordinates with Claims Manager on resolution of customer service inquiries within 24 hours of receipt.
• Assists with Claims adjustment projects as requested.
• May help with Claims entry when requested.
• Completes various work assignments as requested by supervisor in a timely manner.
• Maintains current desk procedures and reference materials.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Two years of medical claims processing experience strongly preferred.

Requirements

• Must have full understanding of insurance processes (Managed Care, Medicare, Medicaid, and Commercial practices).
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of Medicare and Health Care Finance Administration regulations.
• Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs, and authorizations/referrals.
• Ability to read and interpret provider contracts.
• Strong verbal, written, and organizational skills; must be self-directed/self-motivated and possess analytical, problem-solving, and decision-making abilities.
• Accurate keyboard skills.
• Ability to function in a fast-paced, detail-oriented environment.
• Basic math skills.
• High degree of accuracy.
• Team player.

Work Environment

• Current work environment is remote; however, some state exclusions apply.
• Must have access to a reliable and secured internet connection source.
• Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure, or damage and will adhere to all GlobalHealth privacy and security policies.

Travel

• No travel is required.

Supervisory Responsibility

• This position has no supervisory responsibility.

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.