Post Date: 05/17/2017 2017-05-17 Job ID: 8654 Category: Professional
- 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.