Responsible for procedures relating to claims processing. To be able to communicate with members and health care professionals, provide customer service to members and providers of Nesika Health Group,
Processing all claims for payment/denial
Determine pre-existing conditions
Send out pre-existing inquires to members and providers
Obtaining accident information/TPR information
Electronic claims processing/Re-pricing as necessary
Verify insurance eligibility to providers
Relay benefit information to members and providers
Assisting Lead claims Analyst with completing provider 1099’s as necessary.
H.S. Diploma (or equivalent) required.
Four (4) years relevant claims experience OR Bachelors degree & two (2) years relevant experience
Ability to work independently with minimal supervision
Maintain integrity of confidential files/information
Good written and oral communication skills.
General knowledge of COB- coordination of benefits
HIPAA regulations and compliance
Medicare regulations and compliance
Ability to work within Databases
General knowledge of claims adjudication
Knowledge of medical terminology.
Knowledge of ICD-9, CPT, and HCPCS coding
Knowledge of Microsoft Word, Excel and Outlook
Ability to read and interpret general business correspondence, procedure manuals, and specific plan documents.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Excellent keyboarding skills.
Ability to perform basic math functions – addition, subtraction, multiplication, and division.
Ability to work and communicate effectively in a team environment.
Ability to work under pressure.
Ability to work in an environment with fluctuating workloads.
Assistance/Back-up for other office staff that is required due to vacations, sick leave, etc.
Umpqua Indian Development Corporation
- 3 years ago - save job