Doherty Staffing Solutions

Claims Processor IV

Location
Minnetonka, Minnesota
Salary
Depending on Qualifications
Posted
Sep 08, 2017
Closes
Sep 21, 2017
Ref
128183
Category
Healthcare
Job Type
Employee
Employment Status
Full Time

Doherty Top Talent is partnering with a large healthcare company located in Minnetonka, MN. We are seeking a Claims Processor IV on 1st shift for these exciting employment opportunities! This position pays $24-25/hour.

SUMMARY - The Claims Processor IV is the expert resource in terms of claims coding, system capabilities, recommended system application and the implementation of benefits and reimbursement policies for all business segments. They provide coding expertise to claims processors, internal customers on the policies administrated by HealthRules or iCES. They collaborate and consult with the Coding Consultants, Auditors, Claims Management Teams and the Operations Analysts at UHG to ensure proper system implementations and claims processing.

Claims Processor IV Main Duties/Responsibilities

· Reviewing and processing complex provider appeals

· Serve as the first point of contact for claims coding and processing issues related to HealthRules, iCES, deductible/out-of pocket accumulators, provider claims histories, and check void/replacement, based on a variety of inter and intra-departmental needs

· Assist in the training and auditing of new hires

· Serve as a “tester and auditor” for new HealthRules enhancements

· Expected to provide recommendations for claims enhancements or process improvements for claims processing

· Reviewing Policy and Procedure documents to ensure they are current and accurately reflect claims processing requirements

Claims Processor IV Requirements/Qualifications

· 2+ years with CPC Certification

· All candidates submitted must have substantial medical claims processing experience

· High School degree, or equivalent

· Completion and active use of CPC certification within the last 2 years

· Strong written and verbal communication skills

· Ability to identify trends and clearly articulate them

· High ethical standards

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