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Claims Processor Job



Job Number: 76928728059

Location: Pittsburgh, PA

Date Posted: 4-17-2017

 

Wexford Health Sources, one of the nation's leading innovative correctional health care companies, provides clients with experienced management and technologically advanced services, combined with programs that control costs while ensuring quality.  For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.

At Wexford Health our philosophy is that health care should not be considered a luxury for anyone.  We simply care for those in need and the corrections environment is our venue.

Wexford Health has an exceptional opportunity for a Claims Processor to join our team of healthcare professionals in Pittsburgh Corporate Office.

We’re proud to offer a competitive benefits package including:

  • Annual review with performance increase
  • Generous paid-time off program that combines vacation and sick leave
  • Paid holidays
  • Comprehensive health insurance through Blue Cross Blue Shield
  • Dental and Vision insurance
  • 401(k) retirement savings plan
  • Company-paid short-term disability
  • Healthcare and dependent care spending account

POSITION SUMMARY

Responsibilities include but are not limited to adjudicating an average of 100 claims per day which includes calculating payment according to the contracted rates and applying cost containment principles.

 

DUTIES/RESPONSIBILITIES

Responsibilities include supporting all aspects of the technology infrastructure:

  • Enter and Process paper claims HCFA 1500, UB04 within the claims system.
  • Process both hospital and physician, dental, vision, hearing and DME claims.
  • Process 100 medical claims per daily.
  • Apply general processing adjustments and review basic pended claims to determine the appropriateness of the claim status and take necessary action based on status.
  • Examine information including authorizations, payments, denials and resolve outstanding issues to meet client expectations.
  • Report daily claims production.
  • Answer incoming phone calls to facilitate claim resolutions.
  • Resolve simple issues and follow through with complex claims with department leadership.
  • Work with internal departments to resolve authorization and contract issues.
  • Identify and communicate opportunities for process improvement to management.
  • Work professionally and confidentially with patient information.
  • Assumes other duties as assigned and directed.

The duties and responsibilities outlined herein are for payroll purposes only; employees may be assigned other duties as required.

 


EDUCATION/EXPERIENCE REQUIREMENTS

Minimum Qualifications:

  • High school diploma or equivalent.
  • Healthcare claims processing experience.

 

Preferred Qualifications:

  • Good PC skills including proficiency with Microsoft Office applications, Word, Excel and the internet.
  • Previous health care related customer service experience in health care products and /or medical terminology.

  

Other:

Highly self-motivated.

Effective written and verbal communication skills.

Excellent organizational aptitude and attention to detail.

Quality focused with strong analytical and problem-solving skills.

Strong interpersonal skills.

Ability to follow general directions and make adjustments to fit specific situations as needed.

Demonstrates responsiveness with customers.

Good PC skills including proficiency with Microsoft Office Suite products.

Takes initiative completing assignments.

Service orientated and integrity driven with customer concerns.

 

 

EOE/M/F/D/V


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