Claims Processor -Novitas

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers.

Join our winning culture and help transform Medicare for the millions of people who rely on its services.

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

This position is responsible for entering paper and/or electronic claims into the claims system and examining and determining whether to return, request additional information, deny or pay claims following organizational policies and procedures after entry.

After the appropriate training, incumbents are expected to meet the minimum levels for quality and production as measured by the Claims Department.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

100% of time will be spent on one or more of the following activities depending on assignments:

• Accurately examine, interpret and enter claims; resolve edits and first/second level suspense utilizing the claims processing system.
• Perform necessary research and effectively make decisions to properly adjudicate claims utilizing processing manual.
• Identify and communicate problems relevant to the claims processing system and the processing manual and/or guidelines.
• Adhere to all established standard operating procedures.
• Support continuous improvement by identifying process improvements and/or quality enhancements.
• Initiate and respond to written and verbal communications from internal and external sources.
• Perform Claim Adjustments of initial claims for internal and external adjustment reasons. This includes resolving claims suspensions resulting from claim adjustments.
• Resolve Medicare Secondary Payor (MSP) edits/audits/reason codes
• Performs other duties as the supervisor may, from time to time, deem necessary.

• High School Diploma or GED
• 1 year of data entry experience, including accurate keyboard skills
• Proficient with PC's and in Windows based environments; including Microsoft Office (Word, Excel, Outlook)
• Demonstrated analytical skills
• Strong verbal and written communication skills
• Strong interpersonal skills

• Knowledgeable of medical terminology, procedure and denial codes

The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.

Background Investigation:
If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government…