Midwest Operating Engineers Hiring for Medical Claims Processor at Countryside, IL Full Time

Summary/Objective This position is responsible for analyzing and processing facility, ancillary and physician claims, checking them for validity. Medical claims processors review claims for various items, including appropriate billing practices, and coverage based on the Health and Welfare Plan Guidelines. The Processor must possess knowledge of medical terms, such as Current Procedural Terminology (CPT), Health Care Procedure Coding Systems (HCPCS) and International Classification of Diseases (ICD-10) to review the claim accurately.

Essential Functions

• Validate information on all medical claims from members and providers seeking payment from their benefits.
• Thoroughly review all claims to ensure they are no missing or incomplete information.
• Request required information from both internal and external sources to establish if the claim is complete and valid.
• Meet and maintain quality, accuracy, and turnaround standards for claim repricing by verifying and entering correct data.
• Review and research claim processing issues from internal claims staff and clients.
• Communicate to Claims Department Leadership any issues that would impede the accurate and timely processing of claims.
• Follow appropriate HIPAA guidelines related to patient privacy and confidentiality.
• Attend and participate in Claims Department meetings for training purposes.
• Meet and maintain production and audit standard quotas.
• Test and verify new or enhanced system applications, if necessary.
• Other duties as assigned.

Specialized skills/technical knowledge required

· CPC Certification preferred.

· Must have experience with COB including Medicare.

· Must have general medical terminology and anatomy knowledge.

· Ability to multitask, prioritize and work efficiently.

· Must be able to handle a high quality and production environment.· Knowledge of healthcare coding systems and methodologies such as CPT, ICD-10 and DRG.

· Ability to perform several tasks concurrently with ease and professionalism.

· Ability to communicate clearly and concisely, verbally and in writing, in English.

· Ability to work independently and meet deadlines.

· Must be detail oriented.

· Knowledge of ISSI or similar claim processing systems.

· Knowledge of Salesforce is preferred, but not mandatory.

· Ability to resolve conflict.

· Ability to deal with stressful situations involving customer payments.

Education: High School diploma or G.E.D certificate.

Job Type: Full-time

Pay: $30.52 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off

Schedule:

• Monday to Friday

Experience:

• ICD-10: 1 year (Required)

Work Location: In person