Claims Examiner II (Spokane , WA)

Claims Examiner II (Spokane , WA)

23 Apr 2024
Washington, Spokane / coeur d'alene 00000 Spokane / coeur d'alene USA

Claims Examiner II (Spokane , WA)

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COMPANY INFORMATION:

First Choice Health is a Seattle-based, physician and hospital-owned company

serving Washington and the Northwest since 1985. We now serve well over one

million people with our array of products and services. Our Preferred Provider

Organization (PPO) is recognized as the leading independent PPO in Washington

State and has a growing regional presence in Oregon, Idaho, Montana and Alaska.

We occupy a great location close to downtown Spokane, pay competitive salaries and offer a

comprehensive benefits package including medical, dental, vision, health

savings accounts, flexible spending accounts, life and disability insurance,

EAP, 401(k), profit sharing, tuition reimbursement, transportation assistance,

credit union and gym membership discounts.

POSITION SUMMARY:

Responsible for the oversight and timely/accurate claims adjudication for all clients assigned. Claim types would include but may not be limited to data entry, institutional, professional, dental, and adjustments to claims. This position may also have a Quality Assurance component.br>

EXAMPLES OF DUTIES:

1. Processing the different claims types to include Institutional, Professional and Dental Claims.

2. Review, research, and resolve claims in accordance with contracts and policies through the utilization of reference materials and on-line tools.

3. Processing all levels of claims procedures to include COB, SARVW, Pre-X, Adjustments and Action Requests.

4. Addresses and takes appropriate action on Action Requests received within 48 hours of receipt.

5. Consistently maintains department minimum productivity and quality standards for adjudicating claims while maintaining established accuracy guidelines.

6. Provides feedback to unit Manager regarding plan benefits and system issues.

7. Must comply with strict privacy, integrity, confidentiality, availability and maintenance of Protected Health Information.

8. May respond to written correspondence.

9. Provides accurate information regarding benefits, providers, claims, referrals, eligibility, pharmacy, etc.

10. Other projects as assigned.

QUALIFICATIONS:

High school diploma or equivalent required.

Excellent verbal and written communication skills. Experience and training in Conflict Resolution .

Minimum 3 years PHONE RELATED customer service or equivalent experience. Minimum 2 years experience in a TPA or ASO environment.

1 to 2 years current claims experience, preferably in a managed care environment.

Bilingual abilities a plus; at a minimum, the ability to understand and be understood by Spanish speaking individuals.

Ability to handle multiple priorities in a sometimes stressful environment.

Basic computer skills/Word processing/Windows environment preferred.

Must be proficient in CPT, ICD-9, and HCPCS.

If you are interested in viewing other employment opportunities with First Choice Health, please click the following link: http://www.fchn.com/AboutUs/#Jobs

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