Mindlance
BusinessOperations - Claims Analyst 2
Mindlance, Wilmington, North Carolina, United States, 28412
Summary: The main purpose of a Claims analyst is to process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures.Job Responsibilities: Organize and work with detailed office or warehouse records, using computer to enter, access, search and retrieve data. Prepare and review insurance claim forms and related documents for completeness. Provide customer service, such as giving limited instructions on how to proceed with claims or providing referrals to other facilities or contractors. Review claims to determine whether or not claimant is covered under a policy, review policy to determine coverage, and evaluate the extent of a settlement. Authorize claim payments, set reserves on payments, ensure timely disbursement of funds, coordinate or conduct investigations on claims, identify claims with possible recovery from third parties, and consult with attorneys, doctors, and agents in regards to the disposition of complex claims.Education/Experience High school diploma or GED required. Bachelor's degree in Business or related field preferred. 2-4 years experience required.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Position Purpose: Ensure timely processing of pending medical claims. Verify and update information on the submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company protocols and procedures.
Education/Experience: High school diploma or equivalent. 1 year of health insurance industry, claims processing, physician's office or other office services experience. Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.). Ability to perform basic math functions. Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred.
For Centene Dental & Vision Services: Claims refers to dental and/or vision claims. Experience in processing Dental or Vision claims preferred. Working knowledge of ICD-9/10, CDT and dental terminology preferred. Experience with Medicaid or Medicare claims preferred.
For Claims Business Unit: Ability to successfully complete additional progressive claims training programs within 12 months of hire required.
Process first time claims
pply policy and provider contract provisions to determine if claim is payable
Research and determine status of medical related claims
Maintain records, files, and documentation as appropriate
Meet and maintain department production and quality standards
Successfully complete additional progressive claims training programs as required Performs other duties as assigned.
Complies with all policies and standards.
EEO:
"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."
Position Purpose: Ensure timely processing of pending medical claims. Verify and update information on the submitted claims. Review work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company protocols and procedures.
Education/Experience: High school diploma or equivalent. 1 year of health insurance industry, claims processing, physician's office or other office services experience. Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.). Ability to perform basic math functions. Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred. Experience with Medicaid or Medicare claims preferred.
For Centene Dental & Vision Services: Claims refers to dental and/or vision claims. Experience in processing Dental or Vision claims preferred. Working knowledge of ICD-9/10, CDT and dental terminology preferred. Experience with Medicaid or Medicare claims preferred.
For Claims Business Unit: Ability to successfully complete additional progressive claims training programs within 12 months of hire required.
Process first time claims
pply policy and provider contract provisions to determine if claim is payable
Research and determine status of medical related claims
Maintain records, files, and documentation as appropriate
Meet and maintain department production and quality standards
Successfully complete additional progressive claims training programs as required Performs other duties as assigned.
Complies with all policies and standards.