Job Description

Title: Claims Adjudicator Job Type: Full Time-Regular Location: Remote Benefits: Medical, Dental, Vision coverage. 401K, Referral Bonus, PTO Shift: Monday – Friday, 8:00 am – 5:00 pm with potential Saturday work and overtime

A REMOTE ROLE FOR DAYTON, OH, COLUMBIA, SC, LONDON, KY, OR EL PASO, TX

JOB SUMMARY:

The primary function of this position is to process medical claims to completion, ensuring proper payment in accordance with the benefit plan reference and guidelines.

JOB DUTIES & RESPONSIBILITIES:

· Interpreting coding and understanding medical terminology in relation to diagnosis and procedures

· Analyzes and answers inquiries regarding payment, co-pay or deductible amounts, and/or reason for denial.

· Requests all information from internal and outside sources to ascertain completeness and validity of claim including coordination of benefits information.

· Adjudicates for allocation of deductibles, co-pays, co-insurance maximums, and provider reimbursements.

· Analyzes the claims to determine the extent of liability and settles the claims with claimants in accordance with policy provisions.

· Researches claims as needed, assuring that quality levels are achieved.

· Provides internal customer service to function areas for a claim resolution.

· Understands various insurance plans to ensure proper processing.

· Adjusts overpayments, underpayments, and other irregularities.

· Documents phone calls in the system and follows up on issues if needed.

· Exceeds productivity and quality standards as they are determined by the business needs on a continuous basis.

· Works closely with Supervisors and Team Leaders.

· Adheres to departmental policies and procedures.

· Follows all procedures to ensure timely accurate claims review, approvals/denials, and payment as required.

· Maintains and promotes positive employee relations in the work environment.

· Works in a safe manner and reports unsafe activity.

· Maintains high levels of safety awareness, a sound safety process to ensure positive team behaviors, and achievement of safety objectives.

· Ensures that the security and privacy policies, standards, and guidelines are disseminated, understood, and applied in order to protect the informational assets of both the company and its customers.

· Acts in accordance with the organization's information security HR and corporate policies.

· Protects assets from unauthorized access, disclosure, modification, destruction, or interference.

· Reports security events or potential events or other security risks to the organization.

· Other tasks duties and responsibilities as assigned.

EXPERIENCE:

· High School diploma or equivalent

· 3 years experience in health care adjudication.

· Familiarity with claims processing manuals, medical terminology, and CPT codes and basic processing procedures

· Proficiency in the use of claims processing software (preferred: Facets Guiding Care and OnBase)

· Ability to read, write and speak English

· Prepare accurate and grammatically correct written reports

PHYSICAL REQUIREMENTS:

Physical demands with activity or condition requiring a considerable amount of time include sitting and typing/keyboarding using a computer (i.e., keyboard, mouse, and monitor) or adding a machine. Physical demands may include walking, carrying, reaching, standing, and stooping. May require occasional lifting/lowering, pushing, or pulling up to 25 lbs. Repetitive motion is required

Company Description

Exela is a location-agnostic global BPA leader combining industry-specific and multi-industry enterprise software and solutions with decades of experience. Exela serves a growing roster of more than 4,000 customers throughout 50 countries, including over 60% of the Fortune®100. Exela’s software and services include multi-industry department solution suites addressing finance, accounting, human capital management, and legal management, as well as industry-specific solutions for banking, healthcare, insurance, and public sectors and over 18,300 employees operating in 23 countries. For more details please visit http://www.exelatech.com/