Description
CLAIMS ACCOUNTING RESEARCH TECHNICIAN
Contract: 4 months (W2)
Location: Aurora, CO 80014
Job Number: 68138
Client: One of the country's largest health care and health plan providers
Department: Patient Financial Services
Job Description:
- Accurate and complete research, recording, and processing of returned refund checks in conjunction with
collection and recovery activities, and in accordance with Vendor Accounting and Check Receipts procedures. - Reviews claim and/or pre-authorization data element submitted on claims/bills against data applied to the claims system in compliance with NCQA standards of review for checks received.
- Medical claims, pre-authorizations, and bills reviewed at this level may include: Emergency claims, EDI billings, inter-regional, Medicare/Medicare risk, coordination of benefit bills, TPL, and no-fault.
- Notify the adjudicators about claims that need to be reprocessed.
- Ensure adjustments and/or voids are completed in conjunction with collection activity for provider over/under payments.
- Collaborate with Cost Containment Department in obtaining backup from external agencies.
- Assists in audits in analysing and determining compliance requirements according to company products.
- Responds to and assists members and providers with questions.
Required Education, Experience, and Skills:
- High School diploma or GED
- 5 years' experience processing medical claims including POS, PPO, HMO, Medicare, Deductible and Coinsurance, of which 2 years would be in research and/or adjustments.
- Experience must be on an automated system, including preparation of payments for medical bills, using medical terminology, CPT, ICD-9, ICD-10 and UB92 coding for both Medicare and non-Medicare claims.
- Working knowledge of other insurance benefit plans including coordination of benefits, no-fault and workers compensation, accumulation and cost sharing.
- Must have a thorough understanding of all aspects of medical claims processing.
- Must be able to review the work of others and provide feedback.
- Demonstrated customer service skills, customer focus abilities, and the ability to understand customer needs.
- Excellent written and oral communication skills.
- Personal computer terminal skills; including data manipulation and extraction skills.
- Must pass Basic Excel test with at least 70% accuracy.
- Must pass Basic Microsoft Access Database test with at least 70% accuracy.
- Ability to work in a Labor Management Partnership environment.