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
North American Medical Management, California, Inc. (NAMM) develops and manages provider networks, offering a full range of services to...