Hill Physicians Medical Group is looking to improve the accuracy and efficiency of their claims processing by researching and resolving issues related to incoming mail, identifying PDRs and adjustments, and ensuring claims are processed in accordance with Health Plan contracts and company policies.
Requirements
- Working knowledge of CPT codes, ICD-10 codes, Revenue Codes and HCPC codes
- Medical terminology preferred
- Must type at least 40 WPM on a personal computer/keyboard
- Strong research, judgment, decision-making and problem-solving skills
Responsibilities
- Screen and research all claims to ensure the following:
- Accurate final claims adjudication by using on-line computer claims payment system. This includes research on previously processed claims when needed.
- Utilize Epic to document PDRs/adjustments as needed.
- Develop a CRM and generate letters as appropriate.
- Identify billing patterns, processing errors, and/or system issues that inhibit the final adjudication of claims.
Other
- One year internal/external experience or knowledge of claims adjudication at an IPA, Health Maintenance Organization (HMO) or HP
- Ability to work independently or as a team
- Strong written- and verbal-communication skills including maintaining open lines of communication within all departments of the organization
- Ability to work in a fast- paced environment
- Ability to focus on repetitive claims sorting detailed information
