Hospital Claims Processor V

Responsibilities

• Review hospital claims and determine action needed to resolve pended claims
• Process and evaluate hospital claims manually or through claims work flow
• Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies
• Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures
• Review, finalize and respond to call tracking tickets in a timely manner to provider inquires
• Perform additional duties and special projects as assigned by management

Qualifications

• High School Diploma or GED required, some College or Degree preferred
• Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required
• Basic keyboarding skills required
• Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)
• Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes
• Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments
• Able to work well independently and in a team environment
• Ability to meet strict deadlines, work well under pressure and in a fast-paced environment
• Must meet performance standards including attendance and punctuality