American Specialty Health
Remote Worker Considerations:
Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment.
Responsibilities
- Processes claims accurately and efficiently.
- Reviews all incoming claims to verify necessary information.
- Determines that correct member and provider records are chosen and utilized to process claims.
- Enters claims data and information into the computerized Claims Processing System.
- Maintains all required documentation of claims processed and claims on hand.
- Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
- Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.
- Verifies data of scanned paper claims at stated standards.
- Provides backup for other examiners within the department.
- Promotes a spirit of cooperation and understanding among all personnel.
- Attends organizational meetings as required.
- Adheres to organizational policies and procedures.
- Maintains confidentiality of all claim files, claims reports, and claims related issues.
Qualifications
- High school diploma required.
- 6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.
- Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
- Proficient in MS Office.
Core Competencies
- Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
- Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
- Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
- Ability to effectively organize, prioritize, multi-task and manage time.
- Ability to work and maintain production in a work-from-home (WFH) environment
- Demonstrated ability to show self-discipline to meet production goals.
- Demonstrated accuracy and productivity in a changing environment.
- Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions, and to utilize constructive criticism to improve.
- Ability to exercise strict confidentiality in all matters.