Claims Processor 2-Novitas

GuideWell Source; Town of Florida (NY); Remote; USD 38,000 - 48,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Disability benefits

401(k) plan with company match

Telehealth

Job summary

GuideWell Source is seeking a detail-oriented claims entry specialist to enter paper and electronic claims into our system, assess edits, and determine appropriate actions in line with policy. After training, you will be expected to reach quality and production benchmarks within the Claims Department.

Ideal candidates will have at least 1 year of data entry experience, strong PC skills, and excellent communication and analytical abilities.

Qualifications

• 1 year of data entry experience.
• Proficient with Windows and Microsoft Office.
• Strong analytical, verbal and written communication skills.
• Excellent interpersonal skills.

Responsibilities

• Enter claims accurately into the claims system and resolve edits.
• Conduct research and adjudicate claims per processing manual.
• Identify and communicate issues related to the claims processing system.
• Follow established standard operating procedures.
• Support process improvements and quality enhancements.
• Communicate with internal and external sources in writing and verbally.
• Perform claim adjustments for internal and external adjustments.
• Resolve MSP edits/audits/reason codes.
• Other duties as assigned by supervisor.

Skills

Data entry

Keyboard skills

Analytical skills

Verbal communication

Written communication

Interpersonal skills

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

SUMMARY STATEMENT

This position is responsible for entering paper and/or electronic claims into the claims system and examining and determining whether to return, request additional information, deny or pay claims following organizational policies and procedures after entry.

After the appropriate training, incumbents are expected to meet the minimum levels for quality and production as measured by the Claims Department.

ESSENTIAL RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

100% of time will be spent on one or more of the following activities depending on assignments:

• Accurately examine, interpret and enter claims; resolve edits and first/second level suspense utilizing the claims processing system.
• Perform necessary research and effectively make decisions to properly adjudicate claims utilizing processing manual.
• Identify and communicate problems relevant to the claims processing system and the processing manual and/or guidelines.
• Adhere to all established standard operating procedures.
• Support continuous improvement by identifying process improvements and/or quality enhancements.
• Initiate and respond to written and verbal communications from internal and external sources.
• Perform Claim Adjustments of initial claims for internal and external adjustment reasons. This includes resolving claims suspensions resulting from claim adjustments.
• Resolve Medicare Secondary Payor (MSP) edits/audits/reason codes
• Performs other duties as the supervisor may, from time to time, deem necessary.

REQUIRED QUALIFICATIONS

• High School Diploma or GED
• 1 year of data entry experience, including accurate keyboard skills
• Proficient with PC's and in Windows based environments; including Microsoft Office (Word, Excel, Outlook)
• Demonstrated analytical skills
• Strong verbal and written communication skills
• Strong interpersonal skills

PREFERRED QUALIFICATIONS

• Knowledgeable of medical terminology, procedure and denial codes

Requirements

The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.

Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.

Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

"We are an Equal Opportunity/Protected Veteran/Disabled Employer."

This opportunity is open to remote work in the following approved states: AL, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require additional approval. In FL and PA in-office and hybrid work may also be available.

Please email or call 904-791-6794 if you need assistance completing the application process.

We are an equal opportunity employer regarding all employees and applicants regardless of race, color, religion, age, sex, national origin, disability, veteran status, sexual orientation, or any characteristic protected by law.

We take affirmative action to employ and advance qualified individuals with disabilities and veterans in compliance with the Rehabilitation Act and the Vietnam Era Veterans' Readjustment Assistance Act. Applicants are invited to voluntarily self-identify as disabled or a veteran during the application process which will be kept confidential.

GuideWell Source complies with the Drug-Free Workplace Act and all employees must refrain from illegal use of drugs under federal law. Applicants must pass a pre-employment drug screen. Applicants currently using or abusing drugs illegally are unsuitable for employment.