Claims Technician

Description:

The Claims Receipt Technician will be responsible for supporting the claims adjudication staff by providing complete front-end entry and preparation of claims and other information required for adjudication. This includes performing manual charge data entry, review of EDI claim charge exceptions in the Oracle system, utilizing decision-making skills to correctly select and interpret the data resident on the charge to accurately reflect all the information required for adjudication; to perform manual data entry of provider information of claims, to resolve EDI provider exceptions; to perform the manual scanning and indexing of claim related documents into the Document Management System, both batch and single indexing; to provide clerical support functions relating to all mail functions in Offices Services.

Responsibilities Include:

• Enter data obtained from all types of mail - hard copy claim forms, electronic claims, billings and correspondence into the appropriate computer system, according to departmental needs and requirements.
• Search and maintain provider information obtained from manual entry of claims forms or from EDI transmissions of claims in the applicable computer system according to departmental needs and requirements.
• Perform manual or web-based repricing functions, which includes the verification of provider participation applying the appropriate reimbursement schedule and determining the correct discount amount if applicable.
• Perform clerical functions, including but not limited to: Picking up and distributing daily reports. Opening, prepping, sorting, batching and date stamping claims mail. Sorting, folding, and stuffing system generated letters as needed. Retrieving authorizations and matching to the appropriate letters and faxing to the medical records retrieval vendor.

• High School Diploma or equivalent is required
• Must have at least one year of office experience with an emphasis in data entry
• Must be able to analyze all information on incoming correspondence to determine required information to be entered into our system

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