University Health Alliance
Senior Claims Processor
University Health Alliance, Honolulu, Hawaii, United States, 96814
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Senior Claims Processor
Department: Claims Services
FLSA Status: Full Time, Non-Exempt
Salary Level: 4
Position Summary:
Process and adjudicate for payment all types of Provider claims [outsourced, OCR scanned/validated, and EDI CMS 1500, EDI (electronic data interchange), UB04 claims] within established performance standards, claims turnaround and payment accuracy.
Assist the Claim Services Supervisor in training staff, compiling daily workflow reports, tracking claims inventory, system tests, and processing complex and special handle claims. Serves as the backup to the Claim Services Supervisor in his/her absence.
Essential Duties & Responsibilities:
Assist in preparing and implementing written training plan to set daily and weekly goals for new associates or temporary help.
Assist in developing written data entry and pended claims processing procedures.
Assist in completing the Section Operating Report (SOR) daily to track incoming claims, production, and inventory to ensure that production and inventory levels meet department standards.
Complete daily Individual Operating Report (IOR).
Assist in review and process special handle claim cases, including Member Cost Transparency Notices (MCTN) and Letter Of Agreement (LOA) cases for out of state and/or transplant services.
Prepares and processes High-Cost Inpatient claims.
Handles Third Party Liability (TPL) Cases.
Coordinating processes with Out of State Participating Provider Network.
Processing of HCFA 1500, Prescription Drug claims, EDI and UB04 claims.
Data entry and review of outsourced rejected claims.
Assist with Review and Processing of Special Handle Claims Analyzing and calculating coordination of benefit payments.
Minimal Data entry and processing of various claim types.
Requires excellent written, verbal, and interpersonal communication skills.
Must understand and carry out oral and written communication.
Interpersonal Skills: Must remain open to others’ ideas and exhibit a willingness to try new things.
Oral communication: Must speak clearly and persuasively in positive or negative situations.
Written Communication: Must edit work for spelling and grammar, present numerical data effectively and able to read and interpret written information.
Attendance is a major function of the job.
Perform other duties as assigned and asking for additional duties when workload permits.
Required Education and Experience:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Able to interpret group benefit plan coverages.
Proficient in medical terminology, medical billing, medical coding, Anatomy and Physiology.
Able to analyze and calculate Coordination of Benefits information.
Thorough knowledge of the medical claims and drug claims processing software applications.
Able to work as a contributing team member towards achieving management’s stated goals.
High School Diploma.
Three years of medical claims filing and processing experience with at least one year of experience with UHA’s claims processing.
Preferred and Advanced Qualifications:
Associate Degree.
CPC (Certified Professional Coder).
HIPAA Privacy and Security.
URAC standards as applicable to Job.
Physical Demands/Working Conditions:
The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.
Frequent sitting, talking, hearing and use of a computer keyboard and monitor, reaching, bending, standing, and walking.
Occasional climbing, stooping, kneeling, crawling and crouching.
Occasionally required to lift, move and/or carry up to 10 pounds.
This position is eligible to work from home upon management’s approval.
Competitive compensation & excellent benefits offered.
Visit our website at
https://uhahealth.com/page/career-opportunities
to apply and for details about vacant positions.
An Equal Opportunity Employer
#J-18808-Ljbffr
Senior Claims Processor
Department: Claims Services
FLSA Status: Full Time, Non-Exempt
Salary Level: 4
Position Summary:
Process and adjudicate for payment all types of Provider claims [outsourced, OCR scanned/validated, and EDI CMS 1500, EDI (electronic data interchange), UB04 claims] within established performance standards, claims turnaround and payment accuracy.
Assist the Claim Services Supervisor in training staff, compiling daily workflow reports, tracking claims inventory, system tests, and processing complex and special handle claims. Serves as the backup to the Claim Services Supervisor in his/her absence.
Essential Duties & Responsibilities:
Assist in preparing and implementing written training plan to set daily and weekly goals for new associates or temporary help.
Assist in developing written data entry and pended claims processing procedures.
Assist in completing the Section Operating Report (SOR) daily to track incoming claims, production, and inventory to ensure that production and inventory levels meet department standards.
Complete daily Individual Operating Report (IOR).
Assist in review and process special handle claim cases, including Member Cost Transparency Notices (MCTN) and Letter Of Agreement (LOA) cases for out of state and/or transplant services.
Prepares and processes High-Cost Inpatient claims.
Handles Third Party Liability (TPL) Cases.
Coordinating processes with Out of State Participating Provider Network.
Processing of HCFA 1500, Prescription Drug claims, EDI and UB04 claims.
Data entry and review of outsourced rejected claims.
Assist with Review and Processing of Special Handle Claims Analyzing and calculating coordination of benefit payments.
Minimal Data entry and processing of various claim types.
Requires excellent written, verbal, and interpersonal communication skills.
Must understand and carry out oral and written communication.
Interpersonal Skills: Must remain open to others’ ideas and exhibit a willingness to try new things.
Oral communication: Must speak clearly and persuasively in positive or negative situations.
Written Communication: Must edit work for spelling and grammar, present numerical data effectively and able to read and interpret written information.
Attendance is a major function of the job.
Perform other duties as assigned and asking for additional duties when workload permits.
Required Education and Experience:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Able to interpret group benefit plan coverages.
Proficient in medical terminology, medical billing, medical coding, Anatomy and Physiology.
Able to analyze and calculate Coordination of Benefits information.
Thorough knowledge of the medical claims and drug claims processing software applications.
Able to work as a contributing team member towards achieving management’s stated goals.
High School Diploma.
Three years of medical claims filing and processing experience with at least one year of experience with UHA’s claims processing.
Preferred and Advanced Qualifications:
Associate Degree.
CPC (Certified Professional Coder).
HIPAA Privacy and Security.
URAC standards as applicable to Job.
Physical Demands/Working Conditions:
The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.
Frequent sitting, talking, hearing and use of a computer keyboard and monitor, reaching, bending, standing, and walking.
Occasional climbing, stooping, kneeling, crawling and crouching.
Occasionally required to lift, move and/or carry up to 10 pounds.
This position is eligible to work from home upon management’s approval.
Competitive compensation & excellent benefits offered.
Visit our website at
https://uhahealth.com/page/career-opportunities
to apply and for details about vacant positions.
An Equal Opportunity Employer
#J-18808-Ljbffr