Claims Processor I - Remote

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JOB SUMMARY:

Researches and processes claims in accordance with business regulations, internal standards, and processing guidelines. Verifies procedure and diagnosis coding, resolves claim edits and errors, and coordinates with internal departments to maintain accurate claim-related records.

ESSENTIAL FUNCTIONS:

The list of essential functions below is intended to be representative of the tasks performed within this job. Other duties may be assigned based on business need. Researches and processes claims according to business regulations, internal standards, and processing guidelines; verifies the coding of procedure and diagnosis codes. (75%) Resolves system edits, audits, and claims errors through research and use of approved references and investigative sources. (20%) Coordinates with internal departments to work edits and deferrals and updates patient identification, other health insurance, provider identification, and other files as necessary. (5%) Performs other duties and special projects as assigned. This position has no formal supervisory responsibility.

MINIMUM QUALIFICATIONS:

High School Diploma or equivalent. Must be authorized to work in the U.S. Must successfully pass all required pre-employment screenings, including a drug screening. Ability to obtain and maintain any required access approvals, credentials, background clearances, or system access applicable to the assigned contract.

PREFERRED QUALIFICATIONS:

One (1) year of experience in a healthcare or insurance environment. Ability to use complex mathematical calculations. Proficiency in word processing and spreadsheet applications. Proficiency in database software. In addition to meeting the minimum qualifications listed above, an individual must be able to perform each of the established essential functions to perform this job successfully.

KNOWLEDGE, SKILLS, AND ABILITIES:

Strong analytical and organizational skills. Strong oral and written communication skills. Proficient spelling, punctuation, and grammar skills. Basic business math skills. Ability to use standard office equipment. CERTIFICATIONS, LICENSES and REGISTRATIONS: None

TRAVEL:

This position is primarily remote. No routine overnight or out-of-area travel is expected. Attendance at occasional in-person training, meetings, or other contract-required activities may be required.

PHYSICAL REQUIREMENTS:

Employees must be able to perform the essential physical requirements of the position, with or without reasonable accommodation, for extended periods of time. Duties may include: Sitting for extended periods while performing computer-based work. Using hands and fingers for keyboarding, data entry, document review, and other computer tasks. Viewing computer screens, electronic records, spreadsheets, databases, and written materials for extended periods. Communicating verbally and in writing with supervisors, coworkers, customers, and other stakeholders. Occasionally lifting, carrying, or moving standard office materials and equipment weighing up to 25 pounds. These physical requirements may be performed with or without reasonable accommodation.

SAFETY AND ENVIRONMENTAL REQUIREMENTS:

Work is performed primarily in a remote office environment using standard computer and office equipment. The employee is responsible for maintaining a work environment that supports confidentiality, information security, productivity, and safe use of equipment. Employees may experience routine office noise, interruptions, deadlines, and extended periods of computer-based work. Employees are required to comply with company safety policies, information security requirements, confidentiality standards, remote-work requirements, and established contract procedures.

SENSORY REQUIREMENTS:

Requires visual acuity, manual dexterity, concentration, sustained attention to detail, and the ability to read, review, compare, enter, and verify information accurately using computer systems. Requires the ability to communicate effectively through written and verbal means and to distinguish information presented on computer screens and electronic documents. Availability: Full-time schedule is Monday - Friday 7:00 AM – 4:00 PM Central Free medical insurance for employees, and a buy-up option is available. Medical opt-out plan is available for qualified employees. Paid holidays and sick time. Paid vacation is available after one year of employment based on the number of hours worked. Full-time and part-time employees are eligible to participate in the 401k plan on their first day of employment. Additional Supplemental benefits are available including Accident, Critical Illness, Short Term Disability and Hospital. Employee Assistance Program. Accepting applications until positions filled... BAC Providing innovative services for individuals with disabilities to achieve personal success! Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. We are a Drug-Free Workplace, #J-18808-Ljbffr Brevard Achievement Center