Remote Staffing
Job Summary
Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. Knowledge/Skills/Abilities
Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. Manages a caseload of claims. Procures all medical records and statements that support the claim. Makes recommendations for further investigation or resolution. Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues. Supports all department initiatives in improving overall efficiency. Meets department quality and production standards. Other duties as assigned. Job Qualifications
Required Education: HS Diploma or GED Required Experience: 1-3 years Preferred Education: Associate degree or equivalent combination of education and experience Preferred Experience: 3-5 years
Responsible for administering claims payments, maintaining claim records. Monitors and controls backlog and workflow of claims. Ensures that claims are settled in a timely fashion and in accordance with cost control standards. Knowledge/Skills/Abilities
Evaluates the adjudication of claims using standard principles and state specific policies and regulations in order to identify incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims. Manages a caseload of claims. Procures all medical records and statements that support the claim. Makes recommendations for further investigation or resolution. Reduces defects via pro-active identification of error issues as it relates to pre-payment of claims through adjudication and trends and recommending solutions to resolve these issues. Supports all department initiatives in improving overall efficiency. Meets department quality and production standards. Other duties as assigned. Job Qualifications
Required Education: HS Diploma or GED Required Experience: 1-3 years Preferred Education: Associate degree or equivalent combination of education and experience Preferred Experience: 3-5 years