Medical Claims Specialist

Job DetailsJob Location: Colorado Springs Explorer Location - COLORADO SPRINGS, CO 80920Position Type: Full TimeEducation Level: High SchoolSalary Range: $21.09 - $24.25 HourlyTravel Percentage: NoneJob Shift: DayJob Category: Health Care
POSITION SUMMARY: Medical Claims Processors are responsible for processing, adjudicating, and paying all program participant medical insurance claims including performing the daily customer service activities surrounding the claims process.

 

MISSION: Improving lives, Optimizing wellness, Promoting independence

 

COMPETENCIES:


 



Technical Expertise
Problem Solving
Teamwork
Effective Communication
Results Oriented
Personal Credibility
Quality Focus
People Focus
Flexibility



 

 

RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

 


Processes provider claims including validation, coding, data entry, adjudication, and importing/exporting in claims management systems. The standard rate of processing claims is 20 1500s and 8 UBs per day and prior months claims are to be entered and adjudicated by the second business day of the month
Prepares and disburses payment checks with explanation of payments (EOPs) to providers
Performs in depth analysis of complex claims identifying missing and/or incomplete data to determine appropriate resolution
Acts as the primary contact for support and resolution with internal departments, program participants as well as external provider representatives for questions about claim status, appeals, etc.
Assists with research, development, implementation, and documentation of processes including identifying process gaps or issues along with appropriate solutions and inputs those processes into the departmental book of business as requested
Other duties as assigned

Qualifications
High school diploma or equivalent required
Minimum 3 years health insurance claims processing required. Working knowledge of Medicare/Medicaid 1500 and UB claims preferred
Accounts payable experience highly desirable
Strong written and verbal communication skills


 

We strive to provide our employees with a comprehensive and affordable benefits package including Medical and Prescription Drug, Dental, Vision Care, Wellness Program, Telemedicine Program, Flexible Spending Accounts, Health Savings Account, Company Paid Basic Life and Accidental Death & Dismemberment, Company Paid Long-Term Disability, Voluntary Life Insurance, Voluntary Short-Term Disability, Accidental Injury Insurance, Critical Illness, Hospital Indemnity, 403(b) Savings Plan, Legal Shield and IDShield, Employee Assistance Program (EAP), Paid Time-Off plan.  Such benefits are based on applicable state law and factors such as pay classification (full-time, part-time, or PRN/casual), job grade and length of service.