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Claims Examiner I - Health First Health Plans, Per Diem

Company: Health First
Location: Melbourne
Posted on: September 8, 2019

Job Description:

Description:The Claims Examiner I position is located at our Health First Health Plans location in Melbourne. This is an hourly Per Diem/Temporary to full time opportunity. It differs from Health Care's typical per diem roles in that this position will\:

  • Provide a full time schedule for the training period which is approximately 6 weeks long with ongoing learning and on the job training through the first 90 days.
  • Strong commitment of hours to flexible associates.
  • May allow for a full time opportunity based on successful completion of orientation, competency adoption, ability to deliver excellent results, and business need.To be fully engaged inproviding Quality/No Harm, Customer Experience, and Stewardship by beingresponsible and accountable for the accurate and timely claims processing ofall claim types.?Claims must beprocessed with a high level of detailed quality and in accordance with claimspayment policy and by the terms of our customer/provider contractualagreements.
    Actively participate and collaborate with entire department to continuously improve workflows and performance.Communicate identified issues with claims and claims processes to the Lead within the claims department.Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.Adapt to and positively influence change by accepting feedback and capitalizing upon opportunities to continuously improve.Adjudicating claims, while ensuring claims are handled appropriately; claim contains pertinent and correct information for processing; member is eligible for coverage on the date(s) of service; services have the required referral/authorizations; accurate final claims adjudication/adjustments by using on-line computer claims payment system, which includes research on previously processed claims when needed; identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims.Meet the performance goals established for the position in the areas of\: efficiency, accuracy, productivity, quality and attendance.Utilize Claims Department policies & procedures, Support Point, workflows and manuals to meet departmental production and quality metrics.Follow processes and work independently to ensure ability to meet or exceed Key Performance Indicators (attainment and/or productivity targets) aligned with specific function/application.Research claims for completion and appropriateness.Review and handle rejected claims as necessaryEnsure timely, accurate claim processing services to clientTrack and report on any overpayment recovery utilizing refund processEnsure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMC/Medicare guidelines, benefit plan documents/certificates)Insure manually pricing is accurate and appropriate
    Qualification: High school diploma with 6 to 12 months of vocation/post high school education or equivalent work experience Minimum of 1 year or more of claims processing, claims customer service or related health care billing experience. Knowledge of medical benefits, medical and dental terminology Knowledge of claim adjudication and benefit plan application for indemnity plans, HMO plans, POS plans or Medicare Proficient in Microsoft Office including\: Microsoft Word; Excel and Access Excellent? customer service skills with ability to explain complicated benefit issues to members and diffuse hostile encounters Excellent oral and written communication skills

Keywords: Health First, Melbourne , Claims Examiner I - Health First Health Plans, Per Diem, Healthcare , Melbourne, Florida

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