This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
This position involves evaluating claims and providing customer service support.
• Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy and Department guidelines
• Key all final information for claims release into computer
• Respond to telephone customer inquiries verifying eligibility, explaining coverage, quoting benefits and advising on the status of claims
• Maintain information files, worksheet records, benefit quote documentation
• Establish and maintain COB files, applies COB payments for final claim payment
• Research and determine proper CPT procedure and ICD-9 Diagnosis Codes
• Research and respond to written correspondence from participants, providers, and local unions/employers
• Prepare transmittal and send claims to Benefit Review for processing instructions
• Work effectively to achieve acceptable production and accuracy standards
• Display maturity, composure and ability to operate under stress conditions
• Perform other duties as assigned
• Specialty duties include: Enter dates of service on dental pre-determinations, process voided checks and refund checks, maintain weekly disability files and process claims
Qualifications
• Eighteen (18) months experience as a Claims Processor or similar function
• Broad knowledge of medical terminology
• Excellent written and oral communication skills
• Good judgment skills and ability to interpret Department guidelines and contractual benefits
• High school diploma or equivalent
• Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience
Company Description
Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package.
Equal Opportunity Employer
Apply Now
Apply Now