Job Description

SUMMARY:

Responsible for accurate review, input and adjudication of Provider claims in accordance with outside regulation, internal production standards and contractual obligations of the organization.

DUTIES AND RESPONSIBILITIES:

1.      Accurately review all incoming Provider claims to verify necessary information is available.

2.      Accurately enter claims data information into the computerized claims adjudication system

3.      Maintain all required documentation of claims processed and claims on hand

4.      Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.

5.      Maintain production standards established by claims management.

6.      Coordinate resolution of claims issues with other departments or payers.

7.      Assist other departments in claims research

8.      Provide backup for other examiners within the department.

9.      Promote a spirit of cooperation and understanding among all personnel

10.   Attend organizational meetings as required

11.   Adhere to organization policies and procedures

MINIMUM JOB REQUIREMENTS:

High school diploma.

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

·        Strong organizational skills.

·        Knowledge of computers

·        Ability to be flexible in high volume setting