Claim Examiner - 00001 at Fort Scott

Job Description

One of the worlds leading providers of business management solutions. We offer customized services for the healthcare industry.

Job Description

Enters claims data into claim payment system for claims adjudication. Examines, evaluates and processes data to determine eligibility for conformity with or liability under a wide range of individual and group benefit plans.

Other duties and responsibilities include:

• Review health-related claims to see if the costs are reasonable based on the diagnosis
• Reviews plan documents that provide information on requirements, regulations, etc.
• Authorizes appropriate payment, denies claims or refer claims to investigators for more thorough review
• Records daily production using Production Reporting System
• Handles claims in a confidential manner
• Other duties as requested by supervisor or manager

Job Requirements

• High school diploma or equivalent required
• One to three months of related training preferred
• Minimum 1 year of related experience
• Knowledge of group/unit Health Plan requirements and regulations
• Knowledge of medical terminology, ICD-9, CPT and HCPCS coding
• General knowledge of claims adjudication
• Knowledge of HIPAA regulations
• Knowledge of PC applications and systems
• Must be able to sit for extended periods of time

Additional InformationAll your information will be kept confidential according to EEO guidelines.
Country: USA, State: Kansas, City: Fort Scott, Company: Firstsource Solutions Ltd.