Assigned to answer all provider claim resolution calls and adjudicate claims for providers on demand. Must have knowledge of the Medicaid and Correct Coding Guidelines in order to process high level claim resolution calls. Interact with various departments within the health plan and requires a pleasant personality.
Required Skills
Required Experience
A. Work Experience Two years coding experience with CPT-4, HCPCS, and ICD-9 diagnostic coding; familiarity with State of Texas local coding guidelines and Corrective Coding guidelines required. Experience preferred with CCS-P, CPC-H, CPC-P, CEMC, CPMA OR CCS or equivalent credentials. Claims processing and adjudicating or medical billing experience is desired. B. License/Registration/Certification CPT Coding Certification preferred. C. Education and Training High school graduate or equivalent. Completion of a formal Insurance Processor program preferred.