[Hiring] Medical Claims Processor @Cognizant

Role Description

The Medical Claims Processor is responsible for the timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client for issues related to claims adjudication and adjustments, Service Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the Plan Document.

• Responsible for reviewing the data in the claim processing system (Facets) and comparing it with the corresponding UB, HCFA paper, or EDI information.
• Responsible for reviewing medical records when necessary to determine if the service rendered was medically appropriate and criteria has been met.
• Responsible for reviewing claim and line item edits and warning messages for determination of whether to pay claim/line item(s).
• Ensure that all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs.
• Assigned special projects or other duties as determined by management.
• Will work closely with other departments.

Qualifications

• At least a High School Diploma or equivalent is required.
• A minimum of 1 year of medical claims processing is required.
• Facets experience is highly preferred.
• Knowledge of physician practice and hospital coding, billing, and medical terminology, CPT, HCPCS, ICD-9.
• Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims.
• Knowledge of Medicare billing & payment and coverage guidelines and regulations.
• Experience in the analysis and processing of claims, utilization review/quality assurance procedures.
• Must be able to work with minimal supervision.
• Creative thinker with good problem-solving skills specifically related to healthcare claim adjudication.
• Possess the ability to work at a computer for extended periods.
• Must have basic Microsoft Excel skills.

Benefits

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan