Responsibilities:

Evaluate and determine coverage for benefits based on the member's plan/client's processing guidelines. Maintain quality and production standards as defined by client contract and/or management determination of need. Manage time adequately to ensure proper turn around for all tasks such as new claims, pending claims, customer service requests and audit feedback. Work with teammates and supervisor to ensure the needs of the client are being met. Assist in development of process improvement initiatives. Ability to look at processes and offer suggestions for hot keys and efficiencies.

Accountabilities:

Successfully completes all training programs as required. Acts in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handling of protected health information. Execute prompt analytical decision making/research with specific attention to detail. Comply with State laws, policy and company procedures. Utilize specified claims production tracking and reporting procedures.

Education & Experience:

High school diploma or GED One year of claims adjudication experience or equivalent medical billing office experience is preferred.

Language Requirements:

Read and comprehend instructions, discussion, correspondence and memos. Hold a conversation and communicate ideas in an understandable manner. Medical terminology and medical claims coding knowledge is preferred.

Physical Requirements:

Light repetitive movement of digits. Stationary 80% of time at a work station keying and viewing a computer screen. Moving, positioning, and reaching intermittently.

Other Requirements:

Must be able to maintain confidentiality. Must be detailed oriented. Must have ability to stay focused. Must have basic math skills. Must have reading comprehension skills to read and apply the provisions of specific plan documents. Must have ability to work in a windows environment on a PC. Must have effective communication skills. Must be able to work in a team environment. Must be flexible with schedule, including working more or less than a 40 hour week when client inventory levels fluctuate.