Claims Processor I

Under general supervision, ensures accurate and timely insurance claim processing, including resolving claim edits and paper claims for submittal. Resolves denied or unpaid insurance claims promptly.

Responsibilities

• Perform account maintenance: update registration, resolve authorization issues, identify charge corrections, process adjustments as needed, and follow up on denials according to payer rules and departmental policies.
• Use the electronic billing system to follow up on outstanding denied claims and no-response claims.
• Correct claims in the electronic billing system for missing or invalid insurance or patient information; place accounts on hold if unresolved.
• Follow up on denied or no-response claims by contacting third-party payers or using payer websites.
• Gather information from patients or other areas to resolve outstanding denied or no-response claims.
• Research accounts to determine appropriate actions for resolution.
• Keep management informed of issues and trends to enhance operations; escalate slow-pay issues when necessary.
• Use payer websites to stay current on payer rules and changes, including reading newsletters and communicating payer or claim issues and trends.
• Maintain 95% quality standards on account follow-up and activity.
• Maintain productivity standards as set by the management team.
• Perform other duties as assigned.

Requirements

• High School Diploma or equivalent.
• 0–6 months of relevant work experience.

Schedule

• Scheduled weekly hours: 40
• Work shift: Day

Pay

• Pay rate type: Hourly
• Pay grade: Health-20