The primary purpose of this position is to enter data from HCFA-1500 Claim Forms into the Claims Processing System for all accounts. This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization.
· Reviews all incoming claims to verify necessary information.
· Enters claims data and information into the computerized Claims Processing System.
· Maintains all required documentation of claims processed and claims on hand.
· Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
· Maintains production standard; processes an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.
· Provides backup for other examiners within the department.
· Promotes a spirit of cooperation and understanding among all personnel.
· Attends organizational meetings as required.
· Adheres to organizational policies and procedures.
· Maintains confidentiality of all claims files, claims reports, and claims related issues.
· Performs other duties and responsibilities as assigned.
· High school diploma or equivalent.
· Minimum 2 years data entry experience with 10 key and word processing; minimum 8,000 key strokes per hour required.
· Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
· Proficient in MS Office.
· Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
· Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
· Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
· Ability to effectively organize, prioritize, multi-task and manage time.
· Demonstrated accuracy and productivity in a changing environment with constant interruptions.
· Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
· Ability to exercise strict confidentiality in all matters.
Mobility: Primarily sedentary, able to sit for long periods of time.
Physical Requirements: Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in oral and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Environmental Conditions: Usual office setting .
ASH Companies - 24 months ago