Robert Half International CS - Claims Processor - Intermediate in Ontario, California
Description Please Complete
Specific Duties: 1. analyze fee for service FFS and capitated provider contracts 2. minimum 1 to 3 years detail oriented claims processing
review provider contract as needed 4. other duties assigned by management
What are the top 5-10 responsibilities/qualifications for this position? please be detailed on what they will be doing day to day bull Analyze detail oriented claims to determine claims payment o Knowledge of CMS-1500 claim form - Required o Review authorizations o Understand Provider contract o Be able to determine where capitated payment applies versus fee for service bull Apply claim reductions and denials as based on industry standard guidelines utilizing information displayed on each claim through CES review o Knowledge of ICD-10 diagnosis codes and CPT-4 procedure coding bull Apply proper benefit application based on service rendered bull Monitor Error Queues and Denial queues for error corrections bull Seek assistance with claim questions through the Claims Trainer Team Lead and Team Supervisor What software skills are needed? o Microsoft Office knowledge o Crystal Reports preferred o Xcelys claims processing system preferred What are the hours? Training hours? o Monday through Friday 7:00 - 3:30PM o A minimum of one training however may need to extend to two weeks dependent on applicants experience Will you be interviewing face to face or phone phone.
contract to full-time Requirements Basic Office Skills
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