Claims Processing Clerk receives and inputs new healthcare claims, processes payments, researches billing issues, and responds to email and telephone inquiries. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Being a Claims Processing Clerk produces routine and ad hoc reports. Requires a high school diploma. Additionally, Claims Processing Clerk typically reports to a supervisor. The Claims Processing Clerk works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)
Under the supervision of the Manager, the incumbent adjudicates claims and provides phone and/or casino onsite coverage for all member and provider interactions. Accountable for the status of claim age for all group evaluation and daily work flow. Makes adjustments daily to ensure standards are met. High school diploma or GED; one year of college level anatomy or pre-med classes or advanced medical terminology training, including ICD10 and CPT Coding; minimum two to four years’ experience in medical claims processing; word processing and data entry skills; Must have the ability to train employees and familiarity with HIPAA guidelines. Experience with Trizetto QicLink or VBA claims system preferred.
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