Job Description

Job Location: Colorado Springs Explorer Location - COLORADO SPRINGS, CO 80920
Position Type: Full TimeEducation
Level: High School
Salary Range: $21.09 - $24.25 Hourly

Travel Percentage: None
Job Shift: Day
Job Category: Health Care

POSITION SUMMARY: Medical Claims Processors are responsible for processing, adjudicating, and paying all program participant medical insurance claims including performing the daily customer service activities surrounding the claims process.
MISSION: Improving lives, Optimizing wellness, Promoting independence
COMPETENCIES:
- Technical Expertise
- Problem Solving
- Teamwork
- Effective Communication
- Results Oriented
- Personal Credibility
- Quality Focus
- People Focus
- Flexibility
RESPONSIBILITIES AND DUTIES:
ESSENTIAL JOB FUNCTIONS:
- Processes provider claims including validation, coding, data entry, adjudication, and importing/exporting in claims management systems. The standard rate of processing claims is 20 1500s and 8 UBs per day and prior months claims are to be entered and adjudicated by the second business day of the month
- Prepares and disburses payment checks with explanation of payments (EOPs) to providers
- Performs in depth analysis of complex claims identifying missing and/or incomplete data to determine appropriate resolution
- Acts as the primary contact for support and resolution with internal departments, program participants as well as external provider representatives for questions about claim status, appeals, etc
- Assists with research, development, implementation, and documentation of processes including identifying process gaps or issues along with appropriate solutions and inputs those processes into the departmental book of business as requested
- Other duties as assigned
ORGANIZATIONAL (CORE RATING FACTORS):
- Demonstrates support of the Companys Mission, Vision and Core Values
- Provides Exceptional Customer Service
- Ensures discretion with confidential information in accordance with HIPAA guidelines
- Supports a collaborative work environment including courteous, helpful and professional behavior
- Embraces Organizational Excellence through practicing individual time management, efficiency and effectiveness and participating in continuous improvement efforts
- Adheres to and supports all Company policies and procedures
- Supports and practices safe work habits in accordance with policies and procedures
- Brings ideas, problems and concerns forward and participates in resolution and implementation
- Participates in and completes regulatory compliance trainings within the prescribed deadlines
- Attends required meetings
- Maintains skills and knowledge required including written and verbal communication, best practices for industry standards, and computer competency

Qualifications
- High school diploma or equivalent required
- Minimum 3 years health insurance claims processing required. Working knowledge of Medicare/Medicaid 1500 and UB claims preferred
- Accounts payable experience highly desirable
- Strong written and verbal communication skills