Job description
Position Purpose
To adjudicate medical claims for payment in an accurate, timely, and efficient manner.
Essential Position Functions
To adjudicate medical claims for payment in an accurate, timely, and efficient manner.
Essential Position Functions
- Process claims for payment on assigned accounts from aged report, adjudication queue, and internal and external requests.
- Assure claims are paid accordingly based on fee schedule, contract, group policy, and provider.
- Review written correspondence and medical notes to assure claims are paid accurately.
- Meet or exceed all Key Performance Indicator (KPI) quality and production goals.
- Reprocess claims as necessary.
- Answer claims questions from other departments.
- Identify and communicate system issues, billing patterns, training opportunities, etc. to the claims supervisor.
- Comply with all company policies and procedures.
Minimum Requirements of the Position
- High school graduate or equivalent.
- Prior claims processing experience preferred.
- 10 key proficient.
- Basic proficiency in Microsoft Word and Excel.
- Medical terminology and a basic understanding of ICD-10CM, HCPCS and CPT coding is helpful.
- Ability to work in a team environment.
Standard Text to Copy into Websites for GHC/KMTSJ Positions: This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.
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