3427 Facets Claims Processor

Location: Phoenix, AZ, United States
Date Posted: 08-03-2017

  1.  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.
2.  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.
3.  Handling telephone inquiries from members, providers and health plans, including internal client tickets via the Service Desk.
4.  Approving, pending, or denying payment according to the accepted coverage guidelines.
5.  Identifying and referring all claims with potential third party liability (i.e.,. subrogation, COB, MVA, stop loss claims, and potential stop loss files).
6.  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 with regard to claims status, questions or claim payments.
  Education:  High school diploma, GED Certificate or equivalent.
  Experience:  Minimum of one year of related experience.
  Technical Competencies:
  • Knowledge of medical terminology including CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines.

Thanks & Regards
email: deepa@reqroute.com
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