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- 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
- 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
- Dental insurance
- Health insurance
- Vision insurance
- 8 hour shift
- Day shift
- CPT/HCPCS and ICD9: 2 years (Preferred)
- Healthcare: 2 years (Required)
- Trenton, NJ 08610: Relocate before starting work (Required)
Medical Claims Specialist - Trenton, United States - V R Della IT Services Private Limited
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Description
*This position involves:#Medical1
Job Types:
Full-time, Contract
Pay:
$23.50 per hour
Benefits:
Schedule:
Experience:
Medical Claims: 2 years (Required)
Ability to Relocate:
Work Location:
In person % % %%insurance%%