Claims Examiner
In this Role the candidate will be responsible for:
- Processing of Professional claim forms files by provider
- Reviewing the policies and benefits
- Comply with company regulations regarding HIPAA, confidentiality, and PHI
- Abide with the timelines to complete compliance training of NTT Data/Client
- Work independently to research, review and act on the claims
- Prioritize work and adjudicate claims as per turnaround time/SLAs
- Ensure claims are adjudicated as per clients defined workflows, guidelines
- Sustaining and meeting the client productivity/quality targets to avoid penalties
- Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.
- Timely response and resolution of claims received via emails as priority work
- Correctly calculate claims payable amount using applicable methodology/ fee schedule
Requirements:
- 1-3 year(s) hands-on experience in Healthcare Claims Processing
- 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
- High school diploma or GED.
- Previously performing – in P&Q work environment; work from queue; remotely
- Key board skills and computer familiarity –
- Toggling back and forth between screens/can you navigate multiple systems.
- Working knowledge of MS office products – Outlook, MS Word and MS-Excel.
- Must be able to work 7am - 4 pm CST online/remote
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