Claims adjuster Jobs in Nashville, TN

Electronic Data Interchange (EDI) Claims Filing Specialist

Location :

120 Brentwood Commons Way, 8th floor, Brentwood, TN 37027

Shift :

Monday to Friday, 7 : 00 AM to 4 : 00 PM

Job Summary :

The EDI Claims Filing Specialist is responsible for ensuring that claims are accurately submitted to payors, either electronically or via paper, with all required documentation. The role requires detailed compliance with departmental policies and a proactive approach to problem-solving in a fast-paced environment.

Reports to : EDI Manager

Key Responsibilities :

• Prepare claims for submission to payors, ensuring adherence to departmental policies.
• Correct billing and clearinghouse errors to ensure successful claim submissions.
• Research payor filing requirements and provide additional information as needed to resolve filing issues.
• Perform daily reconciliations to account for all claims across the billing system, work queue system, and clearinghouse.
• Process correspondence to resolve any claims-related inquiries.
• Meet departmental performance metrics for production and quality.
• Maintain proficiency with departmental workflows, systems, and tools.
• Adhere to the organization's "Code of Conduct philosophy and "Mission and Value Statement.
• Perform additional duties as assigned.

Desired Skills and Traits :

Basic Skills :

Strong organizational and multitasking abilities to handle multiple demands in a fast-paced setting.

PC Skills :

Proficiency in Microsoft Office applications and other required software.

Customer Orientation :

Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

Communication Skills :

Ability to communicate clearly and concisely, both verbally and in writing, with proper punctuation and grammar.

Interpersonal Skills :

Able to work effectively with colleagues, patients, and external parties to build positive relationships.

Policies & Procedures :

Familiarity with organizational policies, procedures, and systems.

Qualifications :

Physical Demands and Working Conditions :

Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.

Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.