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Claims Processor 2
Ref No.: 16-00460
Location: Little Rock, Arkansas
Client: State of Arkansas
Location: Little Rock,AR
Duration: 2+ Months
 
 
Job Description:
The Claims Processor will use knowledge of coding, benefits, provider manual and claims rules / process understanding to make sure claims are accurately processed in a timely fashion.

This position is in support of the Client.

EDUCATION & EXPERIENCE
-3-5 years of experience in the healthcare industry  in a claims operations or reviewer role
OR
-Equivalent combination of experience, education and training in industry
-Certifications (e.g., Certified Professional Coding Designation) preferred

RESPONSIBILITIES
Accurate and timely reviews claims
Works in collaboration with MMIS Operations and Client to process manual claims
As needed, engage with clinical / medical resources to make accurate clinical and medical necessity determinations
Deep understanding of provider manual, benefit structures and coding
Appreciation of one or more 'pend' states that require manual adjudication

REQUIRED CAPABILITIES
Deep understanding of coding and billing standards (ICD-9, ICD-10, CPT codes, etc.) and medical terminology
Understanding of reimbursement guidelines
Strong problem solving skills and inquisitive mindset to help identify and synthesize patterns (e.g., inappropriate practices)
Highly driven and motivated to learn
Excellent communication skills

JOB MEASUREMENTS & TARGETS
Total claims processed / adjudicated / reviewed
Number of opportunities identified and researched from a claims quality perspective
 
Skill
Required / Desired
Amount
of Experience
 
Medical Claims Processing
Required
3
Years
ICD-9, ICD-10, CPT Codes
Required
3
Years
Medical Terminology
Required
3
Years
CPCD
Highly desired