Vacancy caducado!
OverviewThe Claims Adjudicator shall be responsible for adjudicating and adjusting medical and/or dental claims against established criteria, and in accordance with specific clients SPD’s maintaining goals in accuracy and productivity. The Claims Adjudicator is responsible to respond to client, member, and/or provider inquiries on claim status, benefit designs, and claim payments working in conjunction with the Customer Service Representative.Qualifications
High school diploma required; medical office assistant certificate and/or college degree preferred.
Six (6) months of medical claims processing/medical billing experience, customer service experience preferably in a healthcare related or social services setting; OR combination of experience.
Knowledge of medical billing procedures; CPT and ICD-9 coding and medical terminology knowledge required.
Proficiency with data entry skills and Microsoft Office products.
Solid organizational skills with attention to detail and follow through.
Good written, verbal and interpersonal communication skills. Demonstrated ability to effectively communicate with internal and external customers.
Must be able to work collaboratively. Flexibility to work additional hours as needed.
Ability to meet all department goals to include accuracy and productivity.
Proven examples of displaying the Nova’s values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.
Key AccountabilitiesA. Adjudicate claims based on established policies and procedures for facility, professional, member submitted, pharmacy and dental claim edits. This is inclusive for both in and out-of-network benefits.B. Review vouchers/explanation of payments to identify and resolve claims related issues.C. Continually meet department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication.D. Analyze, identify and research, as needed, edits which demonstrate inconsistency in regards to policy, payment issues and coding issues.E. Maintain current contract, summary plan description and benefit knowledge.F. Ability to adhere to departmental deadlines and turn-around times, in order to be compliant with State and Federal regulations.G. Effective written, verbal and interpersonal communication with other departments within Independent Health to resolve problems related to claims payment.As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here at https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation for additional EEO/AAP or Reasonable Accommodation information.Current Associates must apply internally via their Career Worklet.Independent Health, a not-for-profit health plan headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio of progressive products include HMO, POS and EPO products, Medicare and Medicaid plans, traditional indemnity insurance, individual and small group Exchange products, consumer-directed plans and health savings accounts, plus coverage for self-funded employers.Independent Health has augmented its highly successful insured product portfolio with services employers and employees need to better manage their health care expenses through its affiliate companies, including the Independent Health Foundation, Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, and DxID.Our award-winning customer service, dedication to quality health care and unmatched relationships with physicians and providers has allowed us to be consistently recognized as one of the highest-ranked health insurance plans in the nation.We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.
Vacancy caducado!