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Medical Claim Specialist Jobs
Company | Allied Benefit Systems |
Address | United States |
Employment type | FULL_TIME |
Salary | |
Category | Insurance |
Expires | 2023-06-21 |
Posted at | 11 months ago |
ASSISTANT CLAIM SPECIALIST
- Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
- Independently review, analyze and make determinations of claims for: 1) reasonableness of cost; 2) unnecessary treatment by physician and hospitals; and 3) fraud.
- Review, analyze and add applicable notes in the QicLink system.
- Review Workflow Manager daily to document and release pended claims, if applicable.
- Review Pend and Suspend claim reports to finalize all claim determinations timely.
- Process Medical and Dental claims as well as invoices, in the QicLink system.
- Read, analyze, understand, and ensure compliance with clients’ customized plans
- Learn, adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
- Review billed procedure and diagnosis codes on claims for billing irregularities.
- Analyze claims for billing inconsistencies and medical necessity.
- Assist and support other Claim Specialists as needed and when requested.
- Attend continuing education classes as required, including but not limited to HIPAA training.
- Continuing education in all areas affecting group health and welfare plans is required.
- High School Graduate or equivalent
- Applicants must demonstrate the desire to assist the Team with exceeding all established goals.
- Applicants must have a minimum of two (2) years of medical claims analysis experience (Medicare/Medicaid does not count towards the experience).
- Prior experience with dental and vision processing is preferred, but not required.
- Applicants must have strong analytical skills and knowledge of computer systems.
- Applicants must have knowledge of CPT and ICD-10 coding.
- Prior experience with a Third-party Administrator is highly preferred.
- Communication
- Job Knowledge
- Customer Focus
- Time Management
- Initiative
- Accountability
- Office setting and ability to sit for long periods of time.
- Remote
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