Under the direct supervision of a Claims Processing Supervisor and the general direction of the Manager, Claims Production, this position is responsible for the accurate review, entry and processing of all claims received for payment by AAH.
Principal responsibilities include:
· Research claims for completion and appropriateness.
· Review and handle rejected claims as necessary.
· Evaluate HealthSuite error screen and base payment determination using AAH claims processing guidelines.
· Utilize Claims Department policies & procedures, workflows and manuals to meet Departmental production and quality metrics.
· Meet or exceed established individual production standards and collaborate with other Claims staff to ensure departmental compliance targets are met.
· Meet or exceed a financial standard of 97% and a procedural accuracy standard of 96%.
· Review routine claims and edits to determine the appropriate handling for each including paying, denying or suspending for Claims Processor III or Supervisor review.
· Communicate identified issues with claims and claims processes to Supervisor or Manager.
· Actively participate and collaborate with entire department to continuously improve workflows and performance.
· Perform other duties and special projects as assigned.
EDUCATION OR TRAINING EQUIVALENT TO:
· High School Diploma or equivalent is required.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Knowledge of medical billing and/or medical terminology a plus.
· Knowledge of Medi-Cal or Medicaid programs a plus.
· Ability to work in cooperation with others.
· Ability to communicate effectively, both verbally and in writing.
· Ability to handle multiple projects simultaneously and balance priorities.
· Experience in using computers, including Windows-based applications.
· Experience in the use of Microsoft Office software (Outlook, Word, Excel).