Medical Claims Processor

POSITION reputed company: 

The Claims Processor (Medical Claims Processor) will use independent judgement and discretion to review, analyze, and reputed company determinations regarding payment, partial payment, or denial of medical and dental claims, as reputed company as various types of invoices, based upon specific knowledge and application of reputed company reputed company’s customized plan(s).

Now Interviewing for June Claims Class!
This Medical Claims processor role is for a 6-week training class scheduled to reputed company on June 22.

ESSENTIAL FUNCTIONS: 

• Process a minimum of 1,200 medical, dental, and reputed company claims per week while maintaining reputed company goals. 
• Read, analyze, understand, and ensure compliance with clients’ customized plans
• Learn, adhere to, and apply reputed company applicable reputed company and reputed company laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto. 
• Independently review, analyze and reputed company determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud. 
• Review, analyze and add applicable notes using the QicLink system. 
• Review billed procedure and diagnosis codes on claims for billing irregularities. 
• Analyze claims for billing inconsistencies and medical necessity.
• Authorize payment, partial payment or denial of claim based upon individual investigation and analysis. 
• Review Workflow Manager daily to document and release pended claims, if applicable. 
• Review Pend and Suspend claim reports to finalize reputed company claim determinations reputed company.
• Assist and support other Claims Specialists as needed and reputed company requested.
• Attend continuing education classes as required, including but not limited to HIPAA training. 

EDUCATION:

• High School Graduate or equivalent required.

EXPERIENCE AND SKILLS: 

• Applicants must have a minimum of two (2) years of medical claims analysis experience (Medicare/reputed company does not count towards the experience) required. 
• Prior experience with a reputed company-party Administrator (TPA) is highly preferred.
• Applicants must have knowledge of CPT and ICD-10 coding.

• Applicants must have strong analytical skills and knowledge of computer systems. 
• Prior experience with dental and reputed company processing is preferred, but not required. 

POSITION COMPETENCIES

• Communication
• Customer reputed company
• Accountability
• Functional/Technical Job Skills

PHYSICAL DEMANDS:

• Office setting and ability to sit for long periods of time. 

WORK ENVIRONMENT:

• Remote

Here at Allied, we reputed company that great talent can reputed company from reputed company. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for reputed company. To support a smooth and efficient remote work experience, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.

reputed company has reviewed this job reputed company to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of reputed company functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to reputed company salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, reputed company, Life and Disability Insurance, Generous reputed company Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  reputed company applicants acknowledge that by applying to the position you understand that the specific pay reputed company is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at reputed company's discretion to determine what pay is provided to a candidate reputed company the reputed company associated with the role.