Medical Claims Processor

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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