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Claim Processors

Denver, Colorado
Healthcare Claims Processor (Facets Claims)
Denver CO
Contract


Fully Remote/Work From Home and Equipment will be provided

Function:
  • 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, 
  • 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.
  • Identifying and referring all claims with potential third-party liability (i.e., subrogation, COB, MVA, stop loss claims, and potential stop loss files).
  • Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file regarding claims status, questions or claim payments.
  • 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.
  • Troubleshooting all claims with potential third-party liability, i.e., subrogation, COB, or MVA and stop-loss claims and potential stop loss files.
  • Approving, pending, or denying payment according to the accepted coverage guidelines.
  • Assisting in training of new groups and new staff as needed; assisting the management team in problem resolution, planning, and overseeing workflows; testing and preparing documentation and updating current documentation, as well as providing suggestions and recommendations to improve workflows and departmental efficiencies

Qualifications:
  • 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.
  • FACETS claims Experience good to have
  • BCBS experience good to have
  • Must have Medicare knowledge 
  • Audit experience preferred.
  • Proficient in Excel 
Thanks,
Sweta N
Sr. Technical Recruiter
Reqroute Inc,
Email: Sweta@reqroute.com
Phone: 408-600-2007 Extn: 1015
 
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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