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Company Contact Info
- Fairfax, VA
- Mahesh Kumar
- Phone: 410-988-3372
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nTech Solutions, Inc. • Fairfax, VA
Posted 2 months ago
- Contract-to-Hire, 3 Months
- Resource needed to process medical claims adjustments and file corrections for member accounts.
- Provides timely and accurate processing and adjudication of claims.
- Researches and processes simple claims adjustments and file corrections for member accounts, which may involve various company products, such as indemnity, PPO, HMO, POS, Individual Market, FEP, Dental, vision, etc.
- 50% Examines claims to identify key elements and processing requirements based on diagnosis, provider, paykey, medical policy, contracts, and policies and procedures.
- Efficiently and accurately processes product- or system-specific claims to ensure timely payments are generated.
- Calculates deductibles and maximums, as well as researches and resolves system pends.
- 30% Processes lower dollar volume claims adjustments in accordance with standard policies and procedures to resolve over and underpayments.
- 10% Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.
- 10% Gathers productivity data and compiles weekly and monthly reports on own performance.
- Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.
- Work is frequently and closely supervised and audited for quality assurance.
- Standards for productivity are lower than higher Claims Processor levels, and more training is provided.
- Makes lower dollar volume claims adjustments.
- Work is product or system specific.
- High school degree plus demonstrated work experience beyond high school.
- Medical Claims Processing experience for medical, dental, vision.
- Ability to diagnose codes.
- Understanding of medical billing.
- Demonstrated mathematical, problem-solving, data entry/PC, stress management, and organizational skills.
- Basic written/oral communication skills.
- CPT/ICD 9 experience required.
- Medical Claims background with LuminX experience required.
- Knowledge of Medical terminology required.
- Claims processing, billing, or medical terminology experience.
- Excel Experience preferred.
nTech is an equal opportunity employer. All offers of employment are contingent upon pre-employment drug and background screenings. Only candidates who meet all of the above client requirements will be contacted by a recruiter.