Inpatient Claims Processor I

Responsible for timely and accurate payment of Commercial and Medicaid inpatient hospital claims, answering internal questions, and responding to provider correspondence. This is a full-time work-from-home role.

Location: Remote (US)

Salary: $21.30 - $23.96 hourly

Responsibilities

• Review, process and adjust Commercial and Medicaid inpatient claims.
• Review claims data, interpreting coding and understanding medical terminology in relation to diagnosis and procedures.
• Review, analyze, price, and resolve inpatient claims through the utilization of available resources for moderate to complex inpatient claims, adjustments, and file reviews.
• Process Commercial and Medicaid inpatient claims for all types of contracts (e.g., DRG, per diem, case rate, % of CMS).
• Analyze and apply plan concepts to claims that include deductible, coinsurance, copay out of pocket, etc.
• Examine claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.
• Contact providers and other outside sources for additional information.
• Adjudicate claims to achieve quality and production standards applicable to the position.
• Release claims by deadlines to meet company, state regulations, contractual agreements, and group performance guarantee standards.
• Review Policy and Procedures (P&P) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.
• Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, state, and departmental confidentiality guidelines.
• Perform other duties as assigned.

Requirements

• High School diploma or equivalent.
• 1-2 years medical claims processing experience.
• 10-key proficiency of 135 wpm.
• Type a minimum of 35 wpm.
• Knowledge of medical terminology, CPT codes and ICD-10 codes.
• Strong verbal, written, and interpersonal communication skills.
• Analytical, problem solving and organizational skills.
• Ability to work well under pressure.
• Maintain confidentiality and project a professional business image.
• Ability to maintain balanced performance in areas of production and quality.

Benefits

• Medical, Dental, Vision, Pharmacy, Life, & Disability
• 401K- Matching
• FSA
• Employee Assistance Program
• PTO and Company Paid Holidays

Additional Information

• This is a full-time work-from-home role.
• Work in excess of 37.5 hours per week, including evenings and occasional weekends.
• Works internally with Healthcare Services, Membership Accounting, Customer Service, Hospital Auditors, Provider Correspondence, and Professional Relations. Works externally with providers and vendors.