Lead Medical Claims Processor
Salary undisclosed
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Key Tasks And Responsibilities
documents.Secure Transportation is an Affirmative Action/EEO employer.
- Review for accuracy and completeness of inbound claims.
- Verify member eligibility and validate calculation of the reimbursable amount.
- Create and maintain Excel spreadsheets with necessary data items that serve as upload for payment from Finance.
- Update Itineris with necessary member, rates, and provider data.
- Approve claims that are complete, eligible, and accurate data elements.
- Return claims that are incomplete, inconsistent data elements or duplicates with return reason(s).
- Manage and respond to escalated provider inquiries regarding claims status and payment by researching system for claims history.
- Identify issues, report and propose solutions to the Manager
- Provide resolution for any member or provider escalation.
- Review and provide resolution to Quality Assurance requests/grievances.
- Report to Claims Manager and/or Director weekly and monthly reports.
- Provide technical assistance to staff regarding billing in all appropriate payer types.
- Identify opportunities to enhance and facilitate claims processing procedures.
- Provide root cause analysis regarding claims processing and/or disputes.
- Initiate training for new hires and review standard operating procedures for enhancements or new development.
- Review and keep track of all logs related to finance and member inquiries, audit calls, and any other tracker related to mileage reimbursement.
- Support and facilitate monthly internal department, leadership, and quarterly team building exercises meetings.
- Required: High School Diploma or GED
- Preferred: Supervisory training or experience is preferred but not required
- Knowledge of CMS 1500 forms and fields.
- Knowledge of required transportation HCPCS codes, modifiers, provider Medicaid ID, TIN and NPI.
- Knowledge of state Medicare and Medicaid program guidelines and requirements.
- Strong understanding of Itineris and Excel software.
- Strong data entry skills.
- Excellent customer Service.
- Two or more years of claims processing in a fast-paced environment.
- Strong organizational skills
- Ability to communicate efficiently with multiple areas of the organization
- Strong written and verbal communication skills
- Track claims, payment, and rejections
- Ability to multi-task with frequent interruptions
- Exceptional attention to detail and accuracy
- Identify missing or invalid claims data
- Abide to deadlines
- This is a full time remote hourly position.
- Benefits after 60 days include medical, dental, vision, voluntary life and 401(k).
- No travel is required.
- This position requires working on a sitting position working on a computer and operating a
documents.Secure Transportation is an Affirmative Action/EEO employer.
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