Responsible for accurate review, input and adjudication of Provider claims in accordance with outside regulation, internal production standards and contractual obligations of the organization.
Duties and Responsibilities
- Accurately review all incoming Provider claims to verify necessary information is available.
- Accurately enter claims data information into the computerized claims adjudication system
- Maintain all required documentation of claims processed and claims on hand
- Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
- Maintain production standards established by claims management.
- Coordinate resolution of claims issues with other departments or payers.
- Assist other departments in claims research
- Provide backup for other examiners within the department.
- Promote a spirit of cooperation and understanding among all personnel
- Attend organizational meetings as required
- Adhere to organization policies and procedures
Minimum Job Requirements
High school diploma.
Knowledge, Skills and Abilities Required
- Strong organizational skills.
- Knowledge of computers
- Ability to be flexible in high volume setting