Under supervision, this position is responsible for administering, reviewing, and verifying medical claims previously received e.g., medical/surgical, durable medical equipment (DME), chiropractic, acupuncture, pharmacy, medical services using the Premier system to evaluate the claim for appropriate billing for an assistant surgeon, bundling of codes and contract pricing; performing claims research; requesting medical records for nurse review; and responding to general benefit questions.
1) High School Diploma or GED.
2) 3 years experience in a business environment with 2 years in a health care or insurance setting.
3) 2 years experience in a medical claims processing environment.
4) Knowledge of Medical Terminology.
5) Knowledge of ICD-9 and CPT-4 codes and ability to accurately enter data.
6) Knowledge of plan certificates for group managed care business.
7) PC proficiency to include Word and Lotus Notes.
8) Clear and concise verbal and written communication skills including interpersonal skills.
9) Analytical and problem-solving skills.
PREFERRED JOB REQUIREMENTS:
1) Experience in Image and use of Blue Chip research screens.
2) Claims review or audit experience.
3) Knowledge of Blue Chip, Blue Card Host/Home, Blue Star and IRIS systems. Premier, Prime Therapeutics, and Dashboard.
4) Knowledge of indemnity, AFG, PPO, POS and HMO products.
5) Knowledge of pricing.
6) Delivering training in CPT-4, ICD-9 and HCPCS coding.
7) Organizational skills to accommodate large volumes of reference materials combined with time management skills.
Blue Cross Blue Shield of Illinois - 13 months ago