- The position has direct report to the Operations Supervisor and works cooperatively with Manager and Director of Operations and allied health staff within our Client’s Health Solutions and our Client’s Medical Center.
- Works collaboratively with our Client’s Health Solutions Supervisors, Account Managers, Business Analysts and staff in all areas of our Client’s Health Solutions TPA Services.
- Serves as a resource to Network Development, Membership, Credentialing, Health Services, Finance and Customer Service staff.
- Interacts with other areas and our client’s departments, i.e., Patient Account Services, Patient Financial Services, Recovery and Claims Services and other sites Jacksonville, and Scottsdale.
- Externally interacts with physicians/providers offices and leased network administrators.
- Responsible for ensuring high quality claims adjudication for customers while meeting our Client’s Health Solutions goals for production standards, accuracy and claims turnaround time.
- The position is directly responsible to adjudicate claims accurately and on a timely basis.
- Troubleshooting system and process-related issues as well as participate in quality assurance and continuous improvement initiatives to better service our Client’s Health Solutions customers.
- Requires an Associate’s degree or the equivalent amount of education towards a Bachelor's degree and two years’ experience in business or the healthcare industry.
- Bachelor's degree preferred.
- Demonstrated analytical and problem solving skills;
- Experience with windows based software systems;
- Strong typing skills, data entry speed and 10-key stroke capability with high percent of accuracy; ability to cope with varied levels of workload and multiple tasks;
- Understanding and acceptance of the team concept;
- Excellent organizational and listening skills;
- Strong human relations skills to interact with customers;
- Ability to work well under pressure.
- Must be able to work and self-manage in a fast paced changing environment while making independent decisions.
- Claims processing experience, knowledge of medical terminology, health insurance industry terminology, and CPT-4, CDT, ICD-10 and HCPCS's procedure and diagnosis coding preferred.
- Ability to work in a production-oriented environment.
- Certification in one of the following would be beneficial;
- Registered Health Information Technician (RHIT); Registered
- Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician based (CCS-P), or Certified Professional Coder (CPC) credentials.