The Claims Processor analyzes and reviews claims for accuracy, completeness and eligibility. They will also be responsible for preparing and maintaining reports and records for processing. Specifically, the Claims Processor will analyze and review hospital, physician and subscriber-submitted claims for accuracy, completeness and eligibility via personal computer in a timely manner and in compliance with MTM, MPA and Inter-Plan Performance Scorecard guidelines in order to achieve our BCBSNE strategic goals.
Essential Duties and Responsibilities:
Analyze claims for accuracy and completeness to determine benefits based on specific member and provider contracts, payment rules, COB requirements and provider status in a timely manner.
Review claims to make benefit determinations based on member eligibility status.
Electronically route claims to other departments for review by completing special forms and using workflow tools within our imaging systems.
Perform other special projects as needed.
Research claims for adjudication information and prepare and maintain reports quantifying the claim research.
Must meet or exceed the attendance and timeliness requirements of their departments.
Must work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.
Knowledge, Skills and Abilities:
Ability to meet high production and accuracy standards.
Ability to key 8,500 keystrokes per hour, numerically.
Must have the ability to accept overtime as required during peak periods.
Knowledge of medical terminology as well as ICD-9/CPT-4 coding preferred.
Knowledge of HCFA 1500 and UB92 forms preferred.
Knowledge of health insurance.
Basic office skills.
Education and Training:
High School Diploma or Equivalent is required
One year claims experience OR 1 year in a position at BCBSNE OR one year in a Health related billing office.
Applicants must meet the minimum qualifications to apply
Equal Opportunity Employer - Affirmative Action W/M/D/V
Blue Cross and Blue Shield of Nebraska (BCBSNE) - 20 months ago