Healthcare Facets Claims Processor
Rate: $19/hour on W2
Remote/Work From Home and equipment will be provided
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
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 covered items being allowed, etc.
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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