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Healthcare Claims Processors

Plano, Texas

Healthcare Claims Processor
Plano, TX
Contract

Equipment will be provided

Function:

  • Examining and entering basic and 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 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.
  • 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.
  • Must have Medicare knowledge
  • Audit experience preferred.
  • Proficient in Excel


Sudhanshu Karmalkar
Technical Recruiter
ReqRoute, Inc
Phone: 415-691-4708
Email: sudhanshu@reqroute.com

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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