TO APPLY FOR THIS POSITION, PLEASE CLICK ON THE LINK BELOW:
http://www.cowcreek-nsn.gov/employment/
Claims Examiner II
Job Code: 1135
Department: Benefits Administration
Location: Roseburg, OR
Minimum Hourly: $25.71
POSITION PURPOSE:
This position is responsible for claims production and overseeing the accurate and timely adjudication of claims in accordance with plan benefits and maintain established production and quality standards.
ESSENTIAL FUNCTIONS:
Claim auditing to ensure accuracy of claim processing
Train level I claim examiners
Customer service support
Maintain resource materials with up-to-date information for claims and customer service staff
Adjudicate electronic and manual claims for all lines of coverage (Medical, Dental, Vision) based on coverage benefits, coding guidelines, medical review determination, prior-authorization, and benefit limitations.
Advanced knowledge CPT, HCPCS, ICD10, Revenue codes, CDT, etc.
Ability to research and identify third party liability, coordination of benefits (COB) cases and apply benefits accordingly as well as updating of eligibility records.
Ability to understand and manually calculate all types of claims pricing (Medicare, Medicaid)
Satisfy required quantity/quality claims processing requirements.
Ability to effectively communicate with members, providers, and other team members.
Maintain confidentiality and project a professional business presence and appearance.
Performs other related duties as assigned.
QUALIFICATIONS:
3-5 years medical claims processing experience
Knowledge of Medical Terminology and health benefits required.
Good analytical, problem solving and decision-making skills.
Excellent verbal and written communication skills including active listening.
Proficient computer skills with ability to learn new software.
Organized with attention to detail.
Ability to multi-task and work independently with minimal supervision.
High school diploma or equivalent.
TO APPLY FOR THIS POSITION, PLEASE CLICK ON THE LINK BELOW:
http://www.cowcreek-nsn.gov/employment/
