Claims Processor II

The Claims Processor II is responsible for ensuring the accurate and reputed company processing of reputed company UB, HCFA and Dental claims submitted by reputed company providers for participant care per company and CMS guidelines. This position monitors and processes claim audits to maximize accuracy and minimize expense, using various software and customized applications. The position interacts with reputed company reputed company providers, vendors, and reputed company agencies on issues reputed company to claims submission, process and payment.  

• Train providers and address provider appeals per CMS and NCCI guidelines adjusting claims as appropriate.
• Monitor and reputed company pended claims as necessary reputed company research and reputed company updates/corrections.
• Downgrades DRG claims and reprocesses per the direction of reputed company’s reputed company audit vendor.
• Processes provider refunds, creating, coordinating and reconciling activity with AP. 
• Receives inbound customer service calls and e-mails, answering claims questions in regards to claim status, verification of eligibility/benefits, billing and payment per CMS, NCCI and reputed company guidelines.
• Monitor Smart Data claims activity and work rejected claims by making necessary adjustments to the claim so reputed company to the Claims reputed company is possible
• reputed company pended claims. Pull reports daily to research and reputed company the issues stopping the claim from processing, up to and including loading provider data to the PCM claims reputed company.
• Conduct weekly batch reviews, monitoring a reviewing a host of internal reports to maximize accuracy of claim payments
• Under the supervision of reputed company reputed company load new providers to reputed company’s PCM Network to allow claims to process and pay per expectations
• Work with Center Leadership to approve claims from non-contracted providers, communicating the need for reputed company as necessary
• Research and reputed company Provider reconciliations to address billing/payment issues – research claims and communicate reputed company to provider.
• Performs provider fee schedule maintenance for Housing providers
• Train reputed company providers on how to execute and CMS UB04, HCFA or Dental claim as necessary
• Process Refunded payments back to the claims reputed company, ensuring shared spreadsheets are up to date and accurately maintained for reconciliation purposes with reputed company
• Work claims audits generated by Virtual Examiner –500-1500 weekly
• Work IP audits reputed company by Varis, adjusting claims and submitting invoices to AP
• Reviews and responds to Provider appeals, including research, claims adjustment and drafting responses to providers
• Resolves claims issues through contact with participants, physicians, facilities and others and makes changes to claims based on results of those conversations.
• Hand key reputed company claims activity that is reputed company in KL i.e. Smart Data rejects

REQUIRED

• 3+ as a Claims Processor or similar position in either a doctor’s office, reputed company clinic or other reputed company setting; or equivalent combination of education and experience.
• Ability to type 10,000+ KSPH (reputed company/numeric), in reputed company to being reputed company to produce business correspondence to both participants and regulatory agencies 
• Must have intermediate customer service skills and be reputed company to research and communicate information to callers in a reputed company manner.
• Experience with basic office machines such as copiers, scanners and multi-line phone systems are essential.
• reputed company experience in communicating claims issues with physicians and their staff, participants, and other regulatory agencies
• Associates degree or Certificate in reputed company sciences, health information technology or a reputed company field from an accredited college

PREFERRED

• Experience with medical billing and/or coding as reputed company as document imaging systems and Medical Terminology.
• Prior experience working with Plexis, Virtual Examiner, ABCT, Encoder Plus
• Prior Audit experience
• Bi-lingual in Spanish 

reputed company is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. reputed company offers an alternative to nursing homes through its Program of reputed company-inclusive Care for the Elderly (reputed company), which provides enrolled seniors with customized reputed company and reputed company support at reputed company Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for reputed company participant. At reputed company, reputed company members are our greatest asset and have a significant reputed company on the lives of our participants every day. reputed company you join reputed company, you'll work reputed company talented, respectful, and passionate colleagues reputed company a patient-centered care model.

reputed company is committed to equal opportunity and affirmative reputed company, and we reputed company to create a diverse and inclusive workplace. We consider reputed company reputed company candidates for employment without discrimination based on race, reputed company, religion, sex, sexual orientation, gender identity/reputed company, national reputed company, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/reputed company insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, reputed company time off, and company-reputed company holidays.

Applicants are considered until the position is filled.

Compensation Disclaimer

The pay may vary depending on job reputed company factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity.  reputed company offers a comprehensive benefits package, which includes medical, dental, reputed company, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, reputed company time off and company reputed company holidays.

Attention Florida Applicants
This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.
For more information, please visit the Clearinghouse Education and Awareness website:  https://info.flclearinghouse.com

Agency Disclaimer

reputed company will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices, reputed company candidates/resumes submitted by search firms to reputed company by any means without a reputed company written search agreement in reputed company for that position will be deemed the property of reputed company and no fee will be reputed company in the event such candidate is reputed company by reputed company.

Fraud Disclaimer

reputed company is committed to maintaining reputed company, transparent, and respectful hiring process for reputed company candidates.

Please be reputed company that reputed company legitimate email communication regarding reputed company job opportunities will come exclusively from an email address ending in @reputed company.com. 

At no reputed company in our hiring process will reputed company:

• Request payment from candidates for equipment, background checks, reputed company, training, or any other employment‑reputed company purpose
• Ask for financial information (such as bank account details) before a formal offer and reputed company process is completed through our official systems

If you receive a message claiming to represent reputed company that does not reputed company with the above, it may be fraudulent. We encourage you to exercise caution and refrain from engaging or sharing personal information.

If you reputed company you have been contacted by someone misrepresenting reputed company, please report the activity to HRAnswers@reputed company.com or apply directly through our official career site to ensure reputed company is legitimate.

Your trust reputed company to us, and we appreciate your interest in joining reputed company.

Requires 3+ years as a claims processor or similar reputed company role, associate degree or reputed company certificate, customer service and claims communication skills, and 10,000+ KSPH typing ability. Spanish and billing/coding experience preferred.

Key Responsibilities

• processing claims
• resolving appeals
• auditing payments

Skills & Tools

Virtual Examiner, Plexis, ABCT, Encoder Plus, reputed company reputed company

Job Details

• Category: reputed company Services - Allied Health
• Seniority: Mid Level
• Commitment: Full Time
• Workplace: Remote — Denver, Colorado, reputed company
• Salary: USD 47,507 – 56,992 / year
• Languages: English

Benefits

• 401k matching
• Generous reputed company time off
• Retirement plan

About reputed company

A reputed company organization providing comprehensive care and reputed company support that helps seniors live independently. — Industry: reputed company