Processor IV

Requisition #:



# of openings:

2

Employment Type:

Full time

Position Status:

Permanent

Category:

Bargaining

Workplace Arrangement:

Hybrid

Fund:

1199

SEIU National Benefit Fund

Job Classification:

Non-Exempt

Responsibilities:

• Review suspense reason of medical claims and determine actions to be taken to handle edit

• Verify information entered in medical claims system (QNXT) is correct, including patient's name, provider tax identification number and suffix, diagnosis and procedure codes

• Access medical claim image and other reference materials as appropriate

• Apply contractual benefits, medical policy, and operational procedures to finalize claim

• Handle adjustments and reversals of previously paid medical claims as necessary

• Review and handle call tracking tickets as assigned

• Research eligibility issues in Vitech (V3)

• Review and handle EOBs as assigned

• Research and complete request refund form

• Complete medical inquiry form for Medical Consultant

• Handle complex edits and manual pricing

• Perform additional duties and projects as assigned by management

Qualifications:

• High School Diploma or GED required, some college or degree preferred

• Minimum of two (2) years' experience examining and resolving medical claims in a health insurance or benefits environment required

• Thorough knowledge of medical claims processing including major medical, office visits, surgery, anesthesia, lab and x-rays required

• Knowledge of eligibility systems including Coordination of Benefits (COB) and Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits required

• Excellent oral and written communication skills

• Demonstrated organizational skills with ability to multi-task and follow up

• Good problem-solving skills with ability to work independently and as a team player

• Ability to work independently and as a team player

• Excellent data entry skills with a minimum 6,000 KPH and 6% or less error rate required

• Must meet performance standards including attendance and punctuality