1199SEIU Funds is looking for Processor III in New York, NY.
This local job opportunity with ID 68289580 is live since 10/06/2019.
- Examine medical claims for completeness of information
- Number claims sequentially if necessary
- Data enter claims in the claims processing system (QNXT) based on information given by the provider, verify eligibility in Vi-Tech system
- Process Medicare Part B, Medicaid, Vision, Hearing Aid and Speed Claims (as necessary)
- Manually price claims when required, resolution of claim edits
- Enter appropriate International Classification of Diseases (ICD), Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS) codes, or other local codes and provider identification number.
- Apply contractual benefits, medical policy and operational procedures to resolve medical claims
- Coordinate benefits with other insurance carriers
- Record claim finalization status and save in Document Management System (DMS)
- Return finalized medical claims and incomplete claims with transmittal sheets to designated control stations
- Perform additional duties as assigned by management
- High School Diploma or GED required, some college or degree preferred
- Minimum two (2) years medical claims processing experience in a health insurance or benefits environment required
- Excellent keyboarding skills required (minimum 6,000 kph and 6% or less error rate)
- Knowledge of medical benefits and eligibility systems
- Knowledge of ICD, CPT, and HCPCS codes
- Ability to work well under pressure