Hospital Claims Processor V

Job Title

Responsibilities:

Review hospital claims and determine action needed to resolve pended claims

Process and evaluate hospital claims manually or through claims work flow

Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies

Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures

Review, finalize and respond to call tracking tickets in a timely manner to provider inquires

Perform additional duties and special projects as assigned by management

Qualifications:

High School Diploma or GED required, some College or Degree preferred

Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required

Basic keyboarding skills required

Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)

Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes

Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments

Able to work well independently and in a team environment

Ability to meet strict deadlines, work well under pressure and in a fast-paced environment

Must meet performance standards including attendance and punctuality