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Medical Claims Specialist

ATP2 LLC

Medical Claims Specialist

Waco, TX +1 location
Full Time
Paid
  • Responsibilities

    Job Description

    MEDICAL CLAIMS DATA ENTRY:

    • Utilize the VA-FSC medical claims processing system which incorporates an Internet authorization application, document processing functionality, optical character recognition (OCR) scanning capability and Plexis Claims Manager (PCM) claims processing software.
    • Input and validate medical claims data into the PCM application.
    • Analyze rejected claims data.
    • Review documentation authorizing benefits payments. Determine appropriate amount due to recipient and process all necessary payment transactions.
    • Analyze and audit any overpayments of claims. 
    • Record and issue letters informing debtors of obligations.  
    • Respond to written and oral vendor inquiries; follow up as needed.

    MEDICAL VOUCHER EXAMINATION:

    • Examine vouchers, invoices, claims and other payment requests for medical services for authorized patients. Documents must be accurate, provide adequate documentation or citations, and comply with laws and regulations. Justification submitted must be in compliance with CPT, HCPCS and ICD-9-CM and ICD-10-CM standards.
    • Review claims for completeness and accuracy.
    • Expedite high priority claims as identified by the VAFSC.
    • Complete procedural processing of standardized vouchers for various types of medical expenses.
    • Determine sufficiency of package documentation, which typically includes an itemized invoice.
    • Maintain an understanding of billing and regulations as related to Medicare.
    • Possess knowledge of electronic claims editing and submission capabilities, including on-line claims processing and query systems.
    • Respond to written and oral vendor inquiries.

    PROCESS BULK CLAIMS SUBMISSIONS:

    • Analyze bulk claims and determine appropriate payment amounts.
    • Ensure appropriate diagnostic and procedural coding for all HCFA-1500, UB92 and other claim forms.
    • Prepare claims for payments. Validate appropriate claim adjustments to resolve payment discrepancies.
    • Ensure accuracy of information included in VA-FSC vendor file for medical providers.
    • Interface with VA-FSC activities including mailroom in support of preparation and scanning of paper claims.
  • Qualifications

    Qualifications

    • Requires a high school diploma or its equivalent with 2+ years of experience in the field or in a related area.
    • Must have working knowledge of Microsoft Office Access and Excel.
    • Must have experience working with web-based applications 
    • Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines.
    • Experience processing medical claims and have strong customer service skills
    • Demonstrated success working in a team environment focused on meeting organizational goals and objectives required. 
    • Understanding of billing and follow up regulations as it relates to Medicare. Understanding of electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system. 
    • Familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals. 

    MUST BE ABLE TO GET REQUIRED CLEARANCE

    Additional Information

    ATP2 is an Equal Opportunity Employer. ATP2 does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable state or federal civil rights law.All your information will be kept confidential according to EEO guidelines.

  • Locations
    Waco, TX • Austin, TX