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Sr. Claims Representative

Medix • Anaheim, CA

Posted 1 month ago

Job Snapshot

Full-Time
Degree - High School
Healthcare - Health Services
Health Care

Job Competition

28

Applicants

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Job Description

  • Manages and determines the flow of claims payment paperwork. Audits processed claims ready for payment to determine any necessary adjustments. (20%)

  • Establishes and maintains monthly check production schedule and coordinates holiday exceptions. (10%)

  • Manages cash flow management and communicates any unusual cash requirements based on processed claims. (5%)

  • Responsible for producing reports provided to network finance departments following each check run. (10%)

  • Prepares checks and EOB's for check signature and is responsible to obtain a physical signature where needed. Oversees preparation of signed checks to comply with timely mailing. (20%)

  • Audits and processes manual checks as requested. (10%)

  • Responsible for monthly closing of books and network reconciliation issues. Forwards final report to networks for review. (5%)

  • Processes refund withholds as appropriate and monitors vendor cash flow, deducting appropriate overpayments from providers when requested by Revenue Recovery. Responsible for posting refunds in IDX, requiring extensive knowledge of IDX and claims adjudication. (15%)

  • Responsible to oversee IDX check run process, which includes Electronic Funds Transfer (EFT), identifies and resolves issues in IDX Globals (tables and fields) and to present the issues to Perot as applicable. Test system on issues and works with Perot to resolve. (5%)

Metrics:

  • Ability to process 100 UB04 Commercial and Sr. HMO claims daily, while maintaining a 95% accuracy rate.

Job Requirements

2 + Years in Managed Care setting 1+ Years of claims processing/examining experience within hospital setting - need experience with manually processing UBO4 claims Computer Savvy (Excel and other Microsoft Office products) High School Diploma or GED Must know how and when to manually price a claim
Job ID: 82002
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