To assure claims are sorted by markets, priority, scannable, non-scannable, and health plan responsibility. So that all claims are put through the appointed areas for scanning and manual processing .
- Open, sort, batch and distribute mail according to markets, scan able, manual, ER claims, appeals and Health Plan Risk
- Prioritize, log and track all received claims within excel spread sheets
- Look up provider status daily to identify if providers are contracted or non-contracted
- Look up member eligibility in the diamond system as needed
- Verify validity of CPT & ICD-9 codes within diamond
- Inspect all incoming claims to determine quality and suitability for processing
- Responsible for forwarding all un-cleaned claims to provider and all shared risk claims to the health plan
- Responsible for researching claim tracers
- High School diploma or GED
- 6 months to 1 year experience in medical office or claims environment
- CPT and ICD-9 codes, ability to identify HCFA 1500 and UB-04 forms, light medical office skills, some claims environment, some computer knowledge and familiarity with spreadsheet applications such as excel
NAMM North America Medical Management - 17 months ago
North American Medical Management, California, Inc. (NAMM) develops and manages provider networks, offering a full range of services to...