Claims Adjudicator

Independent Health; Buffalo (NY); Hybride; USD 22 000 - 31 000; Plein temps

Avantages offerts par ce poste

Scorecard incentive

Paid time off

Benefits package

Résumé du poste

Independent Health is seeking a Claims Adjudicator for a hybrid on-site position at our Williamsville location. You will adjudicate and adjust medical and dental claims, respond to inquiries, and ensure accuracy and timely processing in collaboration with customer service.

The ideal candidate has a high school diploma with medical billing or claims experience, familiarity with CPT/ICD-9 coding, and strong data entry and Office skills.

Qualifications

• Six months of medical claims processing/billing experience; customer service in healthcare preferred.
• Knowledge of medical billing; CPT/ICD-9 coding and medical terminology.
• Proficiency with data entry and Microsoft Office products.
• Solid organizational skills with attention to detail and follow-through.
• Good written, verbal and interpersonal communication; ability to communicate with internal and external customers.
• Must be able to work collaboratively; flexible to work additional hours.
• Demonstrated alignment with Nova’s Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.

Responsabilités

• Adjudicate claims per policy for facility, professional, member-submitted, pharmacy and dental edits.
• Review vouchers/explanations of payments to identify and resolve claims issues.
• Meet department performance measures for production, accuracy, knowledge, and timeliness.
• Research edits showing policy, payment or coding inconsistencies.
• Maintain current contracts, summary plan descriptions and benefit knowledge.
• Adhere to deadlines and regulatory requirements.
• Use critical thinking to process claims.
• Navigate systems to locate claim information.
• Read, interpret and apply information to claim scenarios.
• Identify opportunities for process improvements.
• Prioritize and manage claim workload efficiently.
• Communicate effectively with other departments to resolve payment issues.

Connaissances

Medical claims processing

CPT ICD-9 coding

Data entry

Microsoft Office

Organization

Communication

Teamwork

Core 4 principles

Formation

High school diploma

Medical office assistant certificate

College degree

Description du poste

FIND YOUR FUTURE

We’re excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Overview

The Claims Adjudicator is responsible for adjudicating and adjusting medical and/or dental claims against established criteria, and in accordance with specific clients SPD’s maintaining goals in accuracy and productivity. The Claims Adjudicator is responsible to respond to client, member, and/or provider inquiries on claim status, benefit designs, and claim payments working in conjunction with the Customer Service Representative.

Qualifications

• High school diploma required; medical office assistant certificate and/or college degree preferred.
• Six (6) months of medical claims processing/medical billing experience, customer service experience preferably in a healthcare related or social services setting; OR combination of experience.
• Knowledge of medical billing procedures; CPT and ICD-9 coding and medical terminology knowledge required.
• Proficiency with data entry skills and Microsoft Office products.
• Solid organizational skills with attention to detail and follow through.
• Good written, verbal and interpersonal communication skills. Demonstrated ability to effectively communicate with internal and external customers.
• Must be able to work collaboratively. Flexibility to work additional hours as needed.
• Proven examples of displaying Nova’s Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.

Essential Accountabilities

• Adjudicate claims based on established policies and procedures for facility, professional, member submitted, pharmacy and dental claim edits. This is inclusive for both in and out-of-network benefits.
• Review vouchers/explanation of payments to identify and resolve claims related issues.
• Continually meet department performance measures as it relates to production, accuracy, knowledge of policy and procedure and timeliness of claims adjudication.
• Analyze, identify and research, as needed, edits which demonstrate inconsistency in regard to policy, payment issues and coding issues.
• Maintain current contract, summary plan description and benefit knowledge.
• Ability to adhere to departmental deadlines and turn-around times, to be compliant with State and Federal regulations.
• Effectively utilize critical thinking skills to process claims.
• Efficiently navigate through systems and applications to locate information specific to claim scenarios.
• Accurately locate resources and read, interpret, and apply appropriate information to various claim scenarios.
• Identify and communicate process opportunities or improvements.
• Prioritize and manage claim processing workload in an efficient manner.
• Effective written, verbal and interpersonal communication with other departments within Independent Health to resolve problems related to claims payment.

This is a hybrid position with onsite attendance required at our Williamsville location.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $19.00 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Aff Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub.