Medical Claims Specialist
Location: Baton Rouge, Louisiana
Description: Capital Staffing Solutions is at the momment seeking for Medical Claims Specialist right now, this job will be assigned in Louisiana. For detail informations about this job opportunity kindly see the descriptions. POSITION PURPOSE: Researches and verifies complex claims information to ensure the accurate and timely processing of claims. Enters all information needed to process a c! laim. Identifies inconsistencies and makes necessary corrections.
Accountable for complying with all laws and regulations associated with duties and responsibilities. Necessary Contacts:
In order to effectively fulfill this position the Special Claims Processor must be in contact with:
Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Administration Management and staff, Membership and Billing, Administrative Services, and District Offices.
Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans.
QUALIFICATIONS: High school degree or equivalent. One year of related clerical or data entry required. Claims processing experience is preferred. A medical office or medical coding diploma can be used in lieu of the one year experience. Must be ! able to enter data at 4000 keystrokes per hour. Working knowle! dge of relevant PC software.
ACCOUNTABILITIES: Enters coded information, checks claim for completeness and accuracy of information prior to final entry, identifies and resolves inconsistencies, and appropriately returns claims requesting missing information in accordance with established quantity, quality, and timeliness guidelines in order to insure contract benefits are applied correctly, ultimately providing a high degree of customer satisfaction.
Consistently researches procedural questions using the edit manuals, identifies incomplete adjudication instructions found within the manual, offers suggestions for correct adjudication procedures, identifies training issues, and appropriately checks with manager/lead when necessary, to provide excellent quality in claim adjudication.
Maintains and records information necessary for the Work Management Module, number of edits processed and hours worked, on a daily basis, in order to retain histo! rical data needed to continually refine and define the special claims processor position as needed to insure high customer satisfaction.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the accountabilities (essential functions) of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- Physical effort is required to lift, hold, and carry objects up to 15 pounds, occasionally.
- Job duties entail using multiple body parts in a coordinated manner.
- Manual/Finger dexterity in both hands is needed to operate a keyboard and manipulate small objects.
- Sight, hearing, the ability to distinguish colors, ! and touching are required sensory abilities.
- The ability to re! ad, write, calculate, visualize, and analyze are required.
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If you were eligible to this job, please deliver us your resume, with salary requirements and a resume to Capital Staffing Solutions.
Interested on this job, just click on the Apply button, you will be redirected to the official website
This job will be opened on: Wed, 13 Nov 2013 19:06:07 GMT
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