Duties:
Delivers specific delegated Claims tasks assigned by a supervisor. Examines and processes paper claims and/or electronic claims. Determines whether to return, pend, deny or pay claims within policies. Determines steps necessary for adjudication. Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues. Settles claims with claimants in accordance with policy provisions. Compares claim application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries. Completes day-to-day tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues.
Athena Health experience is preferred but not required
This position includes fiduciary duty or access to financial systems: Yes
Skills:
3 Non- Negotiable skills:
- Microsoft Office Products - basic skills
- Attention to detail
- Medical Billing exp (min 1 year)
Education:
High School Diploma
Languages:
English Read Write Speak