Claims Processor

Job Summary

A company is looking for a Claims Processor.

Key Responsibilities:

• Data-enter and adjudicate internal and external claims in accordance with policies and procedures
• Research and pend resubmitted or corrected claims, adhering to governmental guidelines
• Troubleshoot and resolve special handling requirements related to pricing, contracting, and system issues

Required Qualifications:

• Minimum of two years of medical billing or claims processing experience
• Knowledge of CPT-4, ICD-9, and HCPCS codes, as well as CMS 1500 and/or UB04 forms
• Good decision-making skills and ability to meet production standards
• Knowledge of Health Plan policies and/or AHCCCS regulations and IDX system
• Ability to research and process complex claims