Hospital Claims Processor V

Responsibilities

• Review hospital claims and determine action needed to resolve pended claims
• Process and evaluate hospital claims manually or through a claims workflow
• Validate information entered in the hospital claims module (QNXT) and determine the workflow needed to resolve discrepancies
• Finalize hospital claims by applying knowledge of eligibility, benefits, pre‑authorization rules, contractual policy and operational procedures
• Review, finalize and respond to call‑tracking tickets in a timely manner to provider inquiries
• Perform additional duties and special projects as assigned by management

• High School Diploma or GED required; some college or degree preferred
• Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment
• Basic keyboarding skills required
• Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)
• Good knowledge of International Classification of Diseases (ICD‑9, ICD‑10) and Current Procedural Terminology (CPT) codes
• Demonstrated organizational, multitasking, and analytical skills with the ability to follow through on assignments
• Able to work well independently and in a team environment
• Ability to meet strict deadlines, work well under pressure and in a fast‑paced environment
• Must meet performance standards including attendance and punctuality