BroadPath is currently identifying Medicaid Claims Processors for a work from home project. Claims Processors will be responsible for the accurate and timely entry, review, and resolution of simple to moderate complexity claims in accordance with CMS guidelines, procedures, and policies as outlined by our client. Some adjustments will be made.
RESPONSIBILITIES
- Thoroughly review claims to ensure that there is no missing or incomplete information
- Review and research assigned claims by navigating multiple computer system and platforms and accurately capture the data/information necessary for processing (e.g. verifying pricing, prior authorizations, etc.)
- Ensure that the proper benefits are applied to each claim according to claims processing policies and procedures including: grievance procedures, state mandates, CMS guidelines, and benefit plan documents.
- Review all documentation and determine if a visit was necessary and if policy covers the treatment received to determine if a claim will be paid or denied
- Complete denial letters if it is determined that the claim should be denied
Requirements:
- Minimum of one year of recent experience processing Medicare Medicaid claims is required
- Knowledge of medical claim forms (HCFA and UB)
- Knowledge of coding (ICD-9, ICD-10, HCPCS, CPT)
- Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, advanced Microsoft Excel knowledge, etc.)
- Requires excellent verbal and written communication skills
- Ability to remain focused and productive each day though tasks may be repetitive
- Previous work at home (WAH) experience is preferred, but not required
Benefits:
BroadPath Work at Home employees enjoy competitive salary, a flexible work-life balance, and the opportunity for education and advancement. Computer equipment is provided for the duration of the assignment. Learn more about our company at www.Broad-Path.com.
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