Processor III

1199SEIU Funds New York, NY Live
1199SEIU Funds is looking for Processor III in New York, NY. This local job opportunity with ID 68289580 is live since 10/06/2019.

Responsibilities

  • 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

Qualifications

  • 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
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Required Skills

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