ESSENTIAL DUTIES & RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.
Prepares first- level (redetermination) case file requests as requested by the Qualified Independent Contractor (QIC) and forwards these case files within the required timeframes established by CMS (Prep and Forward). This includes pulling information from imaging systems, the Multi Carrier System (MCS), letter writer systems, and the Healthcare Integrated General Ledger Accounting System (HIGLAS). Ensures case files that are being forwarded contain the required elements within the case files as outlined in established QIC procedures. (40%)
Resolves basic, on-line edits and performs data entry of hard copy claims. (30%)
Resolve edits on claims suspending on batch edits. (30%)
• Resolve fundamental and basic edits. This may include making basic mathematical calculations such validating accuracy of submitted charges, researching the Inter or Intranets, requesting additional information from the provider, etc.
Performs other duties as the supervisor may, from time to time, deem necessary.
REQUIRED QUALIFICATIONS
• High School diploma or GED
• 6 months’ work experience; this includes data entry experience and working on a PC in a Windows or similar environment.
• Demonstrated mathematical aptitude – ability to add, subtract, multiply and divide.
• Demonstrated effective interpersonal and verbal communications skills.
PREFERRED QUALIFICATIONS
• 1-3 years working with medical terminology, procedure and denial codes
• 1 year of experience in claims processing
• 1 year of experience in Medicare Fee For Service
• 1-3 years of experience as data processor
• 1-3 years meeting production and quality standards
The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
This opportunity is open to remote work in the following approved states: AL, AK, FL, GA, ID, IN, IO, KS, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY.
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