Job Description
ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to
Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps.
Required
This position requires prior claims processing experience, along with all other noted qualifications.
- Your resume must clearly indicate that you meet the qualifications, including the CPT and ICD 9/10 experience.***
Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.
Adjudicates claims and adjustments as required.
Resolves claims edits and suspended claims.
Maintains and updates required reference materials to adjudicate claims.
Provides backup support to other team/group members in the performance of job duties as assigned.
Manually prices claims with various tools and processes to pay the claims.
Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.
Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.
Auto req ID
425186BR
Minimum Education Required
High School/GED
Job_Category
Health/Medical other
Additional Qualifications/Responsibilities
Demonstrated ability to navigate computer applications.
Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
Demonstrated basic analytical skills.
Basic written/oral communication skills.
Demonstrated reading comprehension and ability to follow provided directions.
General Job Information
Title
Claims Processor II
Grade
19
Work Experience - Required
Claims
Work Experience - Preferred
Education - Required
GED, High School
Education - Preferred
License and Certifications - Required
License And Certifications - Preferred
Salary Range
Salary Minimum
$37,725
Salary Maximum
$56,595
City*
United States
State*
N/A
Job Code
Health-Services health-services
Affiliate Sponsor
Magellan Federal - AFSC
