Medical Claims Specialist - Trenton, United States - V R Della IT Services Private Limited

    V R Della IT Services Private Limited
    V R Della IT Services Private Limited Trenton, United States

    1 month ago

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    Description
    *This position involves:
    Follows adjudication policies and procedures to ensure proper payment of claims.

    Resolves pending claims based on Medicaid rules and regulation established for final processing.

    Resolves claims resolution and/or adjustments/voids.

    Processes claim adjustments through Reversal/Replacement requests submitted by providers.

    Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.

    Meets established production requirements consistently.

    Maintains an accuracy rate of 98% or better.

    Processes financial transactions.

    Review/Resolve LTC Production Reports.

    Data entry of LTC transactions.

    Monitor processing time & unfinished work on a daily basis.

    Process refund/return checks.

    Assist with monthly distribution of LTC TADS.

    Contributes a positive attitude to the team in order to meet department goals.

    Supports all departmental initiatives in improving overall efficiency.

    Assist in monitoring and timely processing of special batches

    *Requirements*Basic knowledge of Microsoft Office Outlook, Word and Excel

    General knowledge of PC

    Good working knowledge of medical claims systems

    Knowledge of CPT/HCPCS and ICD9 coding procedures and guidelines

    Mathematical background a plus

    Good verbal and written communication skills

    Maintain regular attendance based on agreed-upon schedule

    Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

    Ability to establish and maintain positive and effective working relationships with
    coworkers, clients, members, providers and customers

    #Medical1


    Job Types:
    Full-time, Contract


    Pay:
    $23.50 per hour


    Benefits:

    • Dental insurance
    • Health insurance
    • Vision insurance

    Schedule:

    • 8 hour shift
    • Day shift

    Experience:
    Medical Claims: 2 years (Required)

    • CPT/HCPCS and ICD9: 2 years (Preferred)
    • Healthcare: 2 years (Required)

    Ability to Relocate:

    • Trenton, NJ 08610: Relocate before starting work (Required)

    Work Location:
    In person