Medical Claims Processor Jobs

Overview

ISI Professional Services (ISI) is currently recruiting for a Medical Claims Processor (MCP) in Waco, TX. The MCP shall provide technical and professional medical claims processing services in support of our client and its customers. The MCP will assist with processing a large volume of medical claims efficiently and in the prescribed timeframes.

Essential Job Functions & Responsibilities

• The MCP is responsible for the accurate and timely processing of medical claims.
• Determines whether to return, deny or pay claims following organizational policies and procedures.
• Researches and processes claims according to business regulation, internal standards and processing guidelines.
• Assists the lead medical claims processor in training or mentoring new staff members.
• Performs research on claim problems by utilizing approved policies, procedures, reference training materials, forms and coordinates with various internal support areas.
• Ensures claims are processed according to established quality and production standards.
• Coordinates with internal/external departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.
• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
• Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints.
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
• Verifies the coding of procedure and diagnosis codes.

Required Qualifications

• One (1) year experience processing, researching and adjudicating medical claims.
• Thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version) within three months from their date of hire. Understand billing and follow-up regulations as it relates to Medicare within three months from their date of hire.
• Understand electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.

Education Requirements

• High School Diploma

At ISI, we recognize and value our employees as our greatest asset. We offer challenging and rewarding career opportunities as well as highly competitive wages and a comprehensive benefits package. Our company provides a balance to both the work and personal lives of our employees. ISI’s goal is to support employees and their families as they grow personally and professionally.

ISI is a customer service-based organization that values quality, integrity and the power of partnership. We are a company that rewards achievement while encouraging personal growth.

ISI offers a family culture, but despite our small business feel our employees have “big business” opportunities. We offer room to grow and encourage advancement by rewarding outstanding effort.

ISI provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. ISI complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment.

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