Caring With Honor Hiring For Claims Examiner II at Milwaukee, WI  Full Time

Resolve Claims:  Review batch claims assigned on a daily basis that are in an Error, Pended or Payable status.  Resolution may include but is not limited to pricing, assigning benefits, selecting patient, selecting provider, clearing and/or adding specific error, pend or payment Explanation of Payment codes, etc.

Process Claims: Apply plan provisions to medical and behavioral health claims in batch according to Medicaid and/or Medicare requirements, CT billing standards and current claim policies and procedures.  Coordinate benefits with primary insurance as applicable.  Meet internal and client quality and turn-around time requirements.

Production and Quality: Claims turn-around time from receipt to paid as well as quality standards are contractually required by Trilogy and must be met. The volume of claim receipts varies day to day so production required to continually meet the requirements will vary respectively.

Related Activities: Claim adjustments, managing refund requests and receipts, assisting with recoup investigation, reviewing Customer Service requests for reconsideration, and other support role activities.
 

• Knowledge of HCPCS, ICD10 and CPT coding, CMS1500 and UB04 claim forms, coordination of benefits, third party liability
• Basic understanding of health insurance, Medicare, Medicaid
• attention to detail and ability to multi-task
• High degree of integrity
• Excellent verbal and written communication skills
• Exhibit a pleasant and professional manner
• Dependable
• Customer service focus and team player
• Must use computer, fax, copier, scanner, telephone
• Must handle PHI and maintain HIPAA confidentiality at all levels

An Equal Opportunity Employer. Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, or marital status, or the presence of a non-related medical condition or disability