Offer summary

Qualifications:

Prior medical claims experience is required., Experience with ICD-9/10 and CPT coding is essential., Basic analytical skills and communication abilities are necessary., High School diploma or GED is required..

Key responsabilities:

Accurately and timely process all claims according to payment policies.

Adjudicate claims and resolve edits or suspended claims as needed.

Maintain and update reference materials for claims adjudication.

Provide backup support to team members and collaborate with the Quality team.

Job description

Job Description

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.

Candidates must have prior medical claims experience, and experience with ICD-9/10 and CPT.

Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.

Adjudicates claims and adjustments as required.

Resolves claims edits and suspended claims.

Maintains and updates required reference materials to adjudicate claims.

Provides backup support to other team/group members in the performance of job duties as assigned.

Manually prices claims with various tools and processes to pay the claims.

Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.

Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.

Auto req ID

440892BR

Minimum Education Required

High School/GED

Job_Category

Health/Medical other

Additional Qualifications/Responsibilities

Demonstrated ability to navigate computer applications.

Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).

Demonstrated basic analytical skills.

Basic written/oral communication skills.

Demonstrated reading comprehension and ability to follow provided directions.

General Job Information

Title

Claims Processor II

Grade

19

Work Experience - Required

Claims

Work Experience - Preferred

Education - Required

GED, High School

Education - Preferred

License and Certifications - Required

License And Certifications - Preferred

Salary Range

Salary Minimum

$37,725

Salary Maximum

$56,595

City*

United States

State*

N/A

Job Code

Health-Services health-services

Affiliate Sponsor

Magellan Federal - AFSC

Required profile