<p>PURPOSE OF POSITION:</p> <p>The primary purpose of the Claims Analyst I is to perform basic job functions, i.e. evaluation and correctly adjudicate medical, vision and/or dental claims received for clients. These claims must be input in a timely manner, ensuring prompt turn-around time for clients. A Claims Analyst I must be knowledgeable regarding the common variances which can affect health insurance policies. They must be able to recognize problem situations while processing and seek assistance to resolve the problem(s). This position entails meticulous attention to detail.</p> <p>RESPONSIBILITIES & EXPECTIONS:</p> <ul> <li>Prepares and inputs claims into the system, paying close attention to information provided by the system; such as, duplicate bill prompts, coordination of benefits information, precertification notes, reasonable and customary schedules, and benefit calculations. </li><li>Recognizes the need for additional information and requests promptly through pended letters. </li><li>Understands and applies CPT, ICD9 & 10, HCPCS and Medical Terminology as it applies to a submitted claim for consideration. </li><li>Adjusts voids and reopens claims on line, within guideline, to ensure proper adjudication. </li><li>Operates a PC or thin client to obtain and extract information. </li><li>Whenever possible, makes phone calls, to eliminate the need for pended claims. </li><li>Updates employee and dependent notes as needed in understandable format. </li><li>Refers questionable claim situations to supervisor and/or appropriate department for review. </li><li>Keeps an accurate mail count. </li><li>Displays good work habits and organizational skills by working in date order and prioritizing daily work flow; i.e., claims, referrals, questions, and possibly special projects. </li><li>Promptly responds to phone sheets and refund requests. </li><li>Shows consistent progress in meeting quality and performance objectives. </li><li>Insures the accuracy of the data input into the system; being alert to not only claim being processed but to claims previously processed in history. </li><li>Displays a positive attitude and willingness to work as a team. </li><li>Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed. </li><li>Seeks supervisory guidance/approval as appropriate. </li><li>Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar. </li><li>Promotes and demonstrates professional standards to enhance the development of the department. </li><li>Practices ethical conduct. </li><li>Meets acceptable attendance and punctuality expectations (excluding FMLA) </li></ul> <p>The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.</p> <p>All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.</p> <p>QUALIFICATIONS:</p> <ul> <li>Education: High school diploma or GED required. </li><li>Individual should be proficient with basic math skills. </li><li>Able to type a minimum of 40 wpm. </li><li>Experience: Good key board skills, CRT, CPT Coding and ICD10 Coding are a plus. </li><li>Available to work 40 hours per week anytime within the operating hours of the department, Monday through Friday, 6:00am-5:00pm, which may include weekends and holidays. </li></ul> <p>PREFERRED QUALIFICATIONS:</p> <ul> <li>Education: Associate's degree preferred. </li><li>One year experience in physician office claims, accounts payable or accounts receivable, preferably related to insurance or medical field. </li><li>Knowledge of HMO, PPO and Medicare plans/benefits. </li><li>Knowledge of medical terminology. </li><li>Previous experience with Microsoft Word, Excel and Outlook </li></ul> <p>WORKING CONDITIONS:</p> <ul> <li>Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer. </li><li>Office environment with minimal noise level due to computers, printers and floor activity. </li></ul>