Medical Claims Research Tech - 4-6 Month Contract

Claims Accounting Research Technician

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 & 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:

Five (5) years of experience processing medical claims including POS, PPO, HMO, Medicare, Deductibleincluding data manipulation and extraction skills.
Must pass Basic Excel test with at least 70% accuracy.
Must pass Basic Microsoft Access Database test with at least 70% accuracy.
Must be able to work in a Labor Management Partnership environment.
Demonstrated customer service skills, customer focus abilities, and the ability to understand our customer needs.