Claims Processor II

### Exemption Status:

United States of America (Non-Exempt)### $17.92 - $22.85 - $27.78“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”This

position is not eligible for Sponsorship.

Med Impact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

At Med Impact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry.

We are the premier Pharmacy Benefits Management solution!#
** Job Description
**** Summary
* * The successful candidate will work as a member of the Claims Processing team, ensuring accurate and timely processing of Physician, Facility, Dental, and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans, and Minimal Essential Coverage (MEC) plans. Interprets schedules of benefits and plan documents to apply accurate benefits to claims according to the plan design.

Applies internal policy and procedures for claims adjudication, identifies and resolves claim processing errors, adjusts previously processed claims, and logs refunds for claim over payments. Performs data entry of CMS 1500, UB 04, and dental claims, research claim issues, and assists in audit projects. Works under general supervision, relying on instructions, work process guidelines, policies & procedures, and company knowledge/experience to perform job functions, with supervision ranging from close to minimal oversight based on demonstrated skill and performance levels.
** Essential Duties and Responsibilities
** include the following. Other duties may be assigned.
* Accurate and timely processing of Physician, Facility, Dental and Vision claims for multiple plan designs, including traditional PPO plans, Reference Based Pricing (RBP) plans and Minimal Essential Coverage (MEC) plans.
* Adhere to Corporate and Departmental standards including production and quality goals.
* Interpret schedule of benefits and plan documents to apply accurate benefits to claims according to the plan design.
* Identify potential system or plan design issues that would impact the correct adjudication of a claim.
* Effectively communicate with the Management team on claim processing questions and issues.
* Interpretation and application of internal policy and procedures for claims adjudication.
* Identify and resolve the root cause of a claim processing and/or data entry error.
* Adjust previously processed claims.
* Identify claim over payments and log refunds.
* Data entry of CMS 1500, UB 04, and dental claims.
* Research complex claim issues.
* Assist in audit projects
** Supervisory Responsibilities
** No supervisory responsibilities                                   
** Client Responsibilities
** This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written).  One must be able to; manage difficult or emotional client situations;
Respond promptly to client needs;
Solicit client feedback to improve service;
Respond to requests for service and assistance from clients;
Meet commitments to clients.
** Qualifications
* * To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
** Education and/or Experience
** GED/HS Diploma and 1+…