Claims Examiner
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Job Description
Claims Examiner coding and adjudicating healthcare claims for Capital Blue Cross. Reviewing billing errors, researching coverage, and processing adjustments remotely from Pennsylvania.
Responsibilities:
- Code and enter imaged claims and triage adjustments submitted by members, providers, and vendors
- Review and correct online edit errors by interpreting warning messages
- Use appropriate systems and reference documents to research and accurately process claims
- Make coding and payment decisions based on imaged claims and applicable documentation
- Review and process claims in pending status according to procedures, policies, contract specifications, coverage, limitations, and exceptions
- Identify and report possible system or image problems to CPR or a Supervisor
- Perform other duties and assignments as directed
Requirements:
- Must have a high school diploma or GED
- Ability to communicate effectively and professionally in written and verbal form
- Strong attention to detail and interest in preventing errors
- Ability to operate a personal computer and office equipment
- Excellent keyboarding skills
- Dependable and professional
- Initiative and time management skills
- Commitment to teamwork and ability to foster an inclusive culture of diversity
- Ability to accept feedback, learn, and adapt
- Ability to adapt to changing priorities
- Ability to manage workload and complete tasks within established timeframes
- Basic reading and arithmetic skills
- Preferred familiarity with provider billing documents
- Preferred familiarity with medical terminology and ICD-10CM diagnosis, procedure, ancillary, type of service, and qualifier codes
- Preferred knowledge of manual and automated claims processing and Image systems
- Preferred knowledge of claims payment policies and benefits
- Preferred proficiency with Microsoft Windows, Email, Internet browsers, Instant Messenger, and Microsoft Office
- Preferred FACETS claims Coding
- Preferred Facets claims processing
- Preferred WorkDesk Imaging
- Preferred Facets Customer Service Application
- Must be willing and able to work possible mandatory overtime
- Must be able to meet quality, productivity, and behavior expectations
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Training and continuing education
- Flexible environment
- Community volunteering opportunities
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