Claims Accounting Research Technician - 4-6 Months - $25 (70956)

CLAIMS ACCOUNTING RESEARCH TECHNICIAN

CONTRACT: 4-6 months (W2)

LOCATION: Aurora, CO 80014

JOB NUMBER: 70956

CLIENT: One of the country's largest health care and health plan providers

DEPARTMENT: Patient Financial Services

PAY RATE: $25/hr

JOB DESCRIPTION:

- Accurate and complete research, recording, and processing of returned refund checks in conjunction with collection and recovery activities, and in accordance with Vendor Accounting and Check Receipts procedures.
- Reviews claim and/or pre-authorization data element submitted on claims/bills against data applied to the claims system in compliance with NCQA standards of review for checks received. Medical claims, pre-authorizations, and bills reviewed at this level may include: Emergency claims, EDI billings, inter-regional, Medicare/Medicare risk, coordination of benefit bills, TPL, and no-fault.
- Notify the adjudicators about claims that need to be reprocessed.
- Ensure adjustments and/or voids are completed in conjunction with collection activity for provider over/under payments.
- Collaborate with Cost Containment Department in obtaining backup from External agencies.
- Assists in audits in analysing and determining compliance requirements according to our products.
- Responds to and assists members and providers with questions.

REQUIREMENTS:

- 5 years' experience processing medical claims including POS, PPO, HMO, Medicare, Deductible, and Coinsurance, of which 2 years would be in research and/or adjustments
- Experience must be on an automated system, including preparation of payments for medical bills, using medical terminology, CPT, ICD-9, ICD-10 and UB92 coding for both Medicare and non-Medicare claims
- Working knowledge of other insurance benefit plans including coordination of benefits, no-fault and workers compensation, accumulation and cost sharing
- Effective communication skills
- Thorough understanding of all aspects of medical claims processing
- Ability to review the work of others and provide feedback
- Computer skills, including data manipulation and extraction skills
- Demonstrated customer service skills, customer focus abilities, and the ability to understand our customer needs
- Must be able to work in a Labor Management Partnership environment

AS PART OF THE APPLICATION PROCESS, YOU MUST PASS A BASIC EXCEL TEST AND A BASIC MICROSOFT ACCESS DATABASE TEST WITH AT LEAST 70% ACCURACY FOR EACH. A LINK TO TESTS WILL BE EMAILED TO QUALIFIED CANDIDATES.