[Hiring] Claims Processor II @VetJobs

Role Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS

• Our organization works with partner companies to source qualified talent for their open roles.
• The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers.
• If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

• Must have medical/healthcare claims processing experience.
• Experience with list of ICD 9/10 codes and CPT.
• Responsible and accountable for the accurate and timely processing of all claims.
• Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.
• Adjudicates claims and adjustments as required.
• Resolves claims edits and suspended claims.
• Maintains and updates required reference materials to adjudicate claims.
• Provides backup support to other team/group members in the performance of job duties as assigned.
• Manually prices claims with various tools and processes to pay the claims.
• Utilizes reference materials and analyzes updated materials to adjudicate claims.
• This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.
• Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.
• The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job.
• A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

#LI-Remote

Qualifications

• Demonstrated ability to navigate computer applications.
• Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
• Demonstrated basic analytical skills.
• Basic written/oral communication skills.
• Demonstrated reading comprehension and ability to follow provided directions.

Requirements

• Work Experience - Required: Claims.
• Education - Required: GED, High School.

Benefits

• Salary Minimum: $37,725.
• Salary Maximum: $56,595.