- Mokena, IL, USA
- Full Time
Medical, Dental, Vision, 401(k), Life, Optional Life, AD &D, STD, LTC, LTD, Wellness, Vacation, PTO, Holiday,
In this role, the incumbent will work under the supervision of the Claims Supervisor, focused on adjudication of Group Health Plan medical and dental claims utilizing employer and payer specific policies and procedures. Provide telephonic support to employer contact for issues related to claims status, claims adjudication questions, PPO information, provider status, and any basic questions regarding health coverage as stated in the employer's Plan Document.
Intermediate to advance knowledge of Microsoft Excel & Word; Hands-on experience with web-based computer systems
Ability to establish cooperative working relationships with staff and management team; interact with staff and vendors in a professional and courteous manner.
Expertise in researching and analyzing problems and developing and implementing solutions.
Able to anticipate and solve problems
Strong organizational skills and detail oriented
Excellent verbal communication skills
Capable of working in a team, as well as independently, and effectively in a deadline-driven environment
3+ years claims processing
Prior experience with Third Party Administrator
Prior experience with RIMS/Quiclink processing software
Knowledge of physician practice and hospital coding, billing, and medical terminology, CPT, HCSPCS, ICD-10-CM
Experience with UB/institutional (CMS-1450) and/or professional (CMS-1500) claims
Strong knowledge of Medicare billing and payment and coverage guidelines and regulations
Strong experience in the analysis and processing of claims, utilization review/quality assurance procedures, CMS payment methodologies(i.e., Medicare Physician Fee Schedule, Lab, DRG's, Outpatient prospective payments systems, ambulatory surgical center, ESRD, Ambulance, Anesthesia
Must be able to work with minimal supervision
Creative thinker with good skills a problem resolution specifically related to healthcare claim adjudication