Job Title: Medical Claims Processor

The MCP is responsible for the accurate and timely processing of medical claims. Researches and processes claims according to business regulation, internal standards and processing guidelines.

Key Responsibilities
Verifies the coding of procedure and diagnosis codes.Coordinates with internal/external departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessaryExamines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelinesDetermines whether to return, deny or pay claims following organizational policies and proceduresPerforms research on claim problems by utilizing approved policies, procedures, reference training materials, forms and coordinates with various internal support areasCorrects processing errors by reprocessing, adjusting, and/or recouping claimsEnsures claims are processed according to established quality and production standardsAssists the lead medical claims processor in training or mentoring new staff membersResponds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints

Required Qualifications
1 year of experience processing, researching and adjudicating medical claimsShall work to have a thorough understanding of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) standards (or latest version) within three months from their date of hireShall work to understand billing and follow-up regulations as it relates to Medicare within three months from their date of hireShall understand electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query systemShall possess working knowledge of Microsoft Office Suite

Candidates that do not meet the required qualifications will not be considered.