CLAIMS EXAMINER
Clarity Performance
This is a remote position. We are unfortunately not accepting applications from the following states: CA, CO, NJ, NY, OR, RI, VT, WA, DC Responsibilities:
- Evaluate and determine coverage for benefits based on the member's plan/client's processing guidelines.
- Maintain quality and production standards as defined by client contract and/or management determination of need.
- Manage time adequately to ensure proper turn around for all tasks such as new claims, pending claims, customer service requests and audit feedback.
- Work with teammates and supervisor to ensure the needs of the client are being met.
- Assist in development of process improvement initiatives.
- Ability to look at processes and offer suggestions for hot keys and efficiencies.
- Successfully completes all training programs as required.
- Acts in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handling of protected health information.
- Execute prompt analytical decision making/research with specific attention to detail.
- Comply with State laws, policy and company procedures.
- Utilize specified claims production tracking and reporting procedures.
- High school diploma or GED
- One year of claims adjudication experience or equivalent medical billing office experience is preferred.
- Read and comprehend instructions, discussion, correspondence and memos.
- Hold a conversation and communicate ideas in an understandable manner.
- Medical terminology and medical claims coding knowledge is preferred.
- Light repetitive movement of digits.
- Stationary 80% of time at a work station keying and viewing a computer screen.
- Moving, positioning, and reaching intermittently.
- Must be able to maintain confidentiality.
- Must be detailed oriented.
- Must have ability to stay focused.
- Must have basic math skills.
- Must have reading comprehension skills to read and apply the provisions of specific plan documents.
- Must have ability to work in a windows environment on a PC.
- Must have effective communication skills.
- Must be able to work in a team environment.
- Must be flexible with schedule, including working more or less than a 40 hour week when client inventory levels fluctuate.
Vacancy posted 18 hours ago
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