MedImpact Healthcare Systems, Inc.
Claims Processor II
MedImpact Healthcare Systems, Inc., Honolulu, Hawaii, United States, 96814
### Exemption Status:United States of America (Non-Exempt)### $17.92 - $22.85 - $27.78“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.
A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”This position is not eligible for Sponsorship.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!# **Job Description****Summary**The successful candidate will work as a member of the Claims Processing team, ensuring accurate and timely processing of Physician, Facility, Dental, and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans, and Minimal Essential Coverage (MEC) plans. Interprets schedules of benefits and plan documents to apply accurate benefits to claims according to the plan design. Applies internal policy and procedures for claims adjudication, identifies and resolves claim processing errors, adjusts previously processed claims, and logs refunds for claim overpayments. Performs data entry of CMS 1500, UB 04, and dental claims, research claim issues, and assists in audit projects. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform job functions, with supervision ranging from close to minimal oversight based on demonstrated skill and performance levels.**Essential Duties and Responsibilities** include the following. Other duties may be assigned.* Accurate and timely processing of Physician, Facility, Dental and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans and Minimal Essential Coverage (MEC) plans.* Adhere to Corporate and Departmental standards including production and quality goals.* Interpret schedule of benefits and plan documents to apply accurate benefits to claims according to the plan design.* Identify potential system or plan design issues that would impact the correct adjudication of a claim.* Effectively communicate with the Management team on claim processing questions and issues.* Interpretation and application of internal policy and procedures for claims adjudication.* Identify and resolve the root cause of a claim processing and/or data entry error.* Adjust previously processed claims.* Identify claim over payments and log refunds.* Data entry of CMS 1500, UB 04, and dental claims.* Research complex claim issues.* Assist in audit projects**Supervisory Responsibilities**
No supervisory responsibilities
**Client Responsibilities**This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).
One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.**Qualifications**To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.**Education and/or Experience**GED/HS Diploma and 1+ year experience or equivalent combination of education and experience**Computer Skills**Intermediate knowledge of MS Office/Word, Excel, PowerPoint and Outlook. Experience with Windows based database programs is preferred.
Strong aptitude for new programs.**Certificates, Licenses, Registrations**Certified Claims Professional (CCP), Medical Billing and Coding Certificate, or Certified Professional Coder (CPC) not required but highly preferred.**Other Skills and Abilities*** Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.**Reasoning Ability**
* Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.* Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.**Mathematical Skills**
* Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.* Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's.
Ability to perform these operations using units of American money and weight measurement, volume, and distance.**Language Skills*** Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence.
* Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:* Composure* Decision Quality* Organizational Agility* Problem Solving* Customer Focus* Drive for Results* Peer Relations* Time Management* Dealing with Ambiguity* Learning on the Fly* Political Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**Work Location**This position must work on-site at the Honolulu, Hawaii location for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders.
Remote work is not an option for these purposes.**Working Hours**This is #J-18808-Ljbffr
A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”This position is not eligible for Sponsorship.MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!# **Job Description****Summary**The successful candidate will work as a member of the Claims Processing team, ensuring accurate and timely processing of Physician, Facility, Dental, and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans, and Minimal Essential Coverage (MEC) plans. Interprets schedules of benefits and plan documents to apply accurate benefits to claims according to the plan design. Applies internal policy and procedures for claims adjudication, identifies and resolves claim processing errors, adjusts previously processed claims, and logs refunds for claim overpayments. Performs data entry of CMS 1500, UB 04, and dental claims, research claim issues, and assists in audit projects. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform job functions, with supervision ranging from close to minimal oversight based on demonstrated skill and performance levels.**Essential Duties and Responsibilities** include the following. Other duties may be assigned.* Accurate and timely processing of Physician, Facility, Dental and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans and Minimal Essential Coverage (MEC) plans.* Adhere to Corporate and Departmental standards including production and quality goals.* Interpret schedule of benefits and plan documents to apply accurate benefits to claims according to the plan design.* Identify potential system or plan design issues that would impact the correct adjudication of a claim.* Effectively communicate with the Management team on claim processing questions and issues.* Interpretation and application of internal policy and procedures for claims adjudication.* Identify and resolve the root cause of a claim processing and/or data entry error.* Adjust previously processed claims.* Identify claim over payments and log refunds.* Data entry of CMS 1500, UB 04, and dental claims.* Research complex claim issues.* Assist in audit projects**Supervisory Responsibilities**
No supervisory responsibilities
**Client Responsibilities**This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).
One must be able to; manage difficult or emotional client situations; Respond promptly to client needs; Solicit client feedback to improve service; Respond to requests for service and assistance from clients; Meet commitments to clients.**Qualifications**To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.**Education and/or Experience**GED/HS Diploma and 1+ year experience or equivalent combination of education and experience**Computer Skills**Intermediate knowledge of MS Office/Word, Excel, PowerPoint and Outlook. Experience with Windows based database programs is preferred.
Strong aptitude for new programs.**Certificates, Licenses, Registrations**Certified Claims Professional (CCP), Medical Billing and Coding Certificate, or Certified Professional Coder (CPC) not required but highly preferred.**Other Skills and Abilities*** Demonstrated ability to appear for work on time, follow directions from a supervisor, interact well with co-workers, understand and follow work rules and procedures, comply with corporate policies, goals and objectives, accept constructive criticism, establish goals and objectives, and exhibit initiative and commitment.**Reasoning Ability**
* Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.* Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.**Mathematical Skills**
* Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.* Ability to add and subtract two digit numbers and to multiply and divide with 10's and 100's.
Ability to perform these operations using units of American money and weight measurement, volume, and distance.**Language Skills*** Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence.
* Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.**Competencies** To perform the job successfully, an individual should demonstrate the following competencies:* Composure* Decision Quality* Organizational Agility* Problem Solving* Customer Focus* Drive for Results* Peer Relations* Time Management* Dealing with Ambiguity* Learning on the Fly* Political Savvy**Physical Demands**The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.**Work** **Environment**The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).**Work Location**This position must work on-site at the Honolulu, Hawaii location for purposes of providing adequate support to internal clients; being available for face-to-face interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as for facilitation of quick and effective decisions through collaboration with stakeholders.
Remote work is not an option for these purposes.**Working Hours**This is #J-18808-Ljbffr