Job Title: Medical Claims Processor I
Client: Health Care Industry
Duration: 12 months
Location: Fairfax, VA 22031 Purpose:
Under direct supervision, reviews and adjudicates paper/electronic claims.
Ensures claims are handled according to organizational policies and procedures.
Essential Functions:
60%:
Examines and resolves non-adjudicated claims.
Processes product/system-specific claims, calculates deductibles, and ensures timely payments.
Uses automated systems to process and complete claims according to medical policy and contracts. 25%:
Conducts research and applies training materials, medical policies, and procedures to process claims accurately.
Collaborates with the Quality team and leadership for clarity on procedures.
Participates in ongoing training. 10%:
Completes daily productivity reports used for scheduling, quality improvement, and financial planning. 5%:
Collaborates with multiple departments to provide feedback, resolve issues, and answer basic processing questions. Additional Skills:
Claims Processing/Billing Experience, Team Player, Accuracy in Keying, Organization, Reliability
Qualifications: Education:
High School Diploma or GED required. Experience:
Less than one year of experience in processing claim documents required.
Preferred: 1-3 years of experience in claims processing, billing, or medical terminology. Knowledge, Skills, and Abilities: Analytical skills - Proficient Reading comprehension and ability to follow directions - Proficient Basic written/oral communication skills - Proficient Ability to navigate computer applications - Proficient Additional Requirements: Must disclose any event that makes them ineligible for work on Federal health care programs. Ability to work in a fast-paced environment with changing priorities, deadlines, and workloads. Must meet deadlines and handle multiple customer service demands effectively. Ability to communicate positively with both internal and external customers, including challenging situations.
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