Priority Claims Specialist III
Hanger, Inc.
Health Claims Specialist
Sutherland
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- This is a full-time permanent healthcare claims adjudicator position.
- A claims adjudicator determines how much money will be paid after an insurance claim has been examined.
- This is not a customer service or customer facing position.
- This is a data entry position where you will be processing medical claims per the specific client requirements.
- Claims can vary and are highly customized depending on the service level.
- You will work independently with the assistance of knowledge base and support personnel.
- You will also be expected to meet all Key Performance Indicators and Quality goals throughout Training and beyond.
- Work independently, processing claims via data entry for 90% of your day.
- Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines
- Follow up on claims needing additional information
- Refer problem claims to a Lead and/or auditor for additional review
- Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines
- Work with specific software
- May be assigned special projects
- Weekday schedule, Monday – Friday 8:30 AM – 5:00 PM EST.
Requirements
- Data entry
- Time management
- Attention to detail
- Analytical
- High School Diploma or equivalent
- Excellent Internet Connectivity: Internet access speed of 2 Mbps upload and 10 Mbps download – the faster the better.
- house network, and a hard-wired internet connection capable of continuously supporting outstanding call quality and high-speed response rates. (Wireless and/or satellite Internet Service Providers are not compatible with our systems)
- A quiet and distraction-free, secure place to work
- Effective verbal and written communication skills
- Strong typing and analytical abilities
- Multi-tasking skills with a strong attention to detail
- Computer knowledge
- Minimum 40 words per minute on typing test
- Must have and maintain a clean and paper free work environment to meet our company policies.
- Medical Billing and Coding degree/certification.
- Previous experience in a medical office type setting, including some knowledge of insurance, claims, billing or coding, with an understanding of the different types of insurance (Medicare/Medicaid and/or Child Plus).
- Knowledge of Medical terminology
