Hospital Claims Processor V - New York - 1199SEIU Funds

    1199SEIU Funds
    1199SEIU Funds New York

    6 hours ago

    Description

    Job Title

    Responsibilities

    • Review hospital claims and determine action needed to resolve pended claims
    • Process and evaluate hospital claims manually or through claims work flow
    • Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies
    • Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures
    • Review, finalize and respond to call tracking tickets in a timely manner to provider inquires
    • Perform additional duties and special projects as assigned by management

    Qualifications

    • High School Diploma or GED required, some College or Degree preferred
    • Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required
    • Basic keyboarding skills required
    • Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)
    • Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes
    • Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments
    • Able to work well independently and in a team environment
    • Ability to meet strict deadlines, work well under pressure and in a fast-paced environment
    • Must meet performance standards including attendance and punctuality

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