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Claims Processor

Phoenix, AZ
Role: Claims Processor
Location: Phoenix, AZ
Position Type: W2 Hourly
 
 
 
PURPOSE: Processing basic payments and/or claim denials for group health which includes medical, dental, vision, FSA, HSA, HRA and disability benefits; demonstrating the highest levels of customer service, technical skills and professionalism.
 
ESSENTIAL FUNCTIONS:
•             Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
•             Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
•             Approving, pending, or denying payment according to the accepted coverage guidelines.
•             Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
•             Processing complex claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
•             Approving, pending, or denying payment according to the accepted coverage guidelines.
•             Knowledge of HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification, provider verification and preauthorization desirable.
 
Requirements
•             High School diploma or GED required
•             2-3 years Claims processing or  directly related work experience.
•             Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.
•             Must have FACETS exp
•             Must have Medicare knowledge
 
 
Thanks & Regards,
Harry
Technical Recruiter
Reqroute, Inc
Recruiting solutions for the digital world
Desk # 415-960-3175
 
Companies across U.S. have engaged ReqRoute, Inc to deliver skilled, dedicated IT professionals. Recruiting is our passion and we support Fortune 1000 companies with their hiring needs. We always seek to deliver competitive and sought-after career opportunities to our potential consultants and employees. We invite you to review the position requirements and apply today if your skills match our needs.  
 
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)

 
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