Job title: Sr. Claims Examiner
Company: Mphasis
Job description: Job description Job Description: Senior Claims Examiner Summary: Under the supervision of the Claims Manager, the Senior Claims Examiner is responsible for analyzing and processing claims and meeting defined quality and productivity standards. Esse
Job description Job Description: Senior Claims Examiner Summary: Under the supervision of the Claims Manager, the Senior Claims Examiner is responsible for analyzing and processing claims and meeting defined quality and productivity standards. Essential Functions: Claims Processing . Evaluates claims for completeness and validity to determine payment/denial according to provider contracts, authorizations, and Medicare processing guidelines . Processes various Medicare and Medicaid claim types, including Professional, Facility and Dental claims . Accurately analyzes and interprets provider contracts . Researches claims and makes appropriate adjustments System Testing . Assists with system configuration and testing for new clients . Assists with testing of new processes, and provides feedback . Reviews and tests fee schedules Backup Coverage (as requested) . Reviews and approves batch close reports for examiners . Analyzes and authorizes high dollar claims . Determines appropriate payment for claims submitted for reconsideration (payment appeals) Additional Functions: . Assists with training new or existing staff, as requested . Responds to clients inquiries related to claims processing . Communicates clearly and concisely, with sensitivity to the needs of others . Maintains courteous, helpful and professional behavior on the job displays a willingness and ability to be responsive in a warm and caring manner to all customer groups consistently cooperates and supports organization in problem solving issues ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards will support the success of the entire team establishes and maintains effective working relationships with co-workers . Follows all Policies and Procedures and HIPAA regulations . Maintains a safe working environment . Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees . Establishes and maintains effective working relationships with co-workers . Participates in any required training sessions/seminars . Participates in special projects as requested Supervisory Responsibility: None Travel: Minimal travel, less than 10% is expected for this position. For remote positions, travel is required for initial training and for necessary, subsequent training. Travel may also be required for company events. Knowledge, Skills and Abilities: . Education/Experience – Educational requirements include a high school diploma or equivalent. Five years of PACE plan management and/or claims processing knowledge required, along with current knowledge of Peak systems . Requires working knowledge of ICD-10, CPT, Revenue, and HCPCS coding, along with understanding of APC and DRG reimbursement . Requires knowledge of current computer technology, including the use of computers knowledge and proficiency with associated software, including Excel and Word . Skilled in establishing and maintaining effective working relationships with co-workers and clients . Skilled in problem resolution recommends suggestions to increase accuracy and/or efficiency . Detail-oriented with ability to focus for extended periods . Ability to work independently, seeking supervision as needed . Ability to communicate professionally, clearly and effectively, verbally and in writing . Ability to meet attendance requirements to effectively fulfill all functions of the position . Ability to independently follow through on assigned tasks, without prompting . Ability to prioritize effectively and multitask Physical Demands & Requirements : . Communicates by way of the telephone with participants, customers, vendors and staff . Operates a computer and other office productivity machinery, such as a calculator, copy machine, fax machine and office printer . Remains stationary for extended periods of time . Occasionally exerts up to 20 pounds of force to lift, carry, push, pull or move objects . Visual acuity to perform activities such as identifying, inputting and analyzing data on a computer terminal and/or in hard copy . Frequent, repetitive use of hands/fingers entering information on a keyboard . Occasional reaching to retrieve shelved items Work Environment : . This job operates in a home-office environment, or a professional office environment with a conversational noise level. . No substantial exposure to adverse environmental conditions is expected . Moderate pressure to meet scheduled appointments and deadlines . Potential for occasional verbal aggression by clients and vendors Supervised by: Claims Manager Skills PRIMARY COMPETENCY : Healthcare PRIMARY SKILL : Non-Voice PRIMARY SKILL PERCENTAGE : 100
Expected salary:
Location: India
Job date: Sun, 25 Sep 2022 22:32:41 GMT
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