$90000 - $125000 Year
Monday to Friday
Morning shift
Day shift
Evening shift
Health insurance
Paid time off
Employee discount
Dental insurance
Vision insurance
401(k)
401(k) matching
Flexible schedule
Parental Leave
Tuition reimbursement
Flexible spending account
Retirement plan
Others
Job Overview:
This position will be responsible for timely and accurate adjudication of professional and hospital claims using payer specific policies and procedures. You will provide support to claims and client for issues related to claims adjudication and adjustments, Service Now and Inquiry resolution, and any basic questions regarding health coverage as stated in the employer's Plan Document.
Responsibilities:
Review the data in the claim processing system, and comparing with corresponding UB or HCFA paper or EDI information
Review medical records when necessary to determine if service rendered was medically appropriate and criteria has been met
Review claim and line item edits and warning messages for determination of whether to pay claim/line item(s)
Ensuring all designated tasks are handled within the appropriate timeframe in order to meet internal and external SLAs
Assigning special projects or other duties as determined by management
Possess ability to work at a computer for extended periods
Qualifications:
A minimum of 1 years claims processing
High School degree or equivalent
Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9
Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims
Knowledge of Medicare billing & payment and coverage guidelines and regulations
Experience in the analysis and processing of claims, utilization review/quality assurance procedures
Must be able to work with minimal direction
Creative thinker with good skills to resolve problems specifically related to healthcare claim adjudication
Will work closely with other departments
Cognizant will only consider applicants for this position whom are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.
Communication
Leadership
Teamwork
Interpersonal
Learning/adaptability
Self-management
Organizational
Computer
Problem solving
Open mindedness
Strong work ethic
technology
Others
A minimum of 1 years claims processing
High School degree or equivalent
Experience with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims
Experience in the analysis and processing of claims
Construction
On going position
General Location, within a limited area