In this Role the candidate will be responsible for:Processing of Professional claim forms files by providerReviewing the policies and benefitsComply with company regulations regarding HIPAA, confidentiality, and PHIAbide with the timelines to complete compliance training of NTT Data/ClientWork independently to research, review and act on the claimsPrioritize work and adjudicate claims as per turnaround time/SLAsEnsure claims are adjudicated as per clients defined workflows, guidelinesSustaining and meeting the client productivity/quality targets to avoid penaltiesMaintaining and sustaining quality scores above 98.5% PA and 99.75% FA.Timely response and resolution of claims received via emails as priority workCorrectly calculate claims payable amount using applicable methodology/ fee schedule
Requirements:1-3 year(s) hands-on experience in Healthcare Claims Processing2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software toolsHigh school diploma or GED.Previously performing – in P&Q work environment; work from queue; remotelyKey board skills and computer familiarity –Toggling back and forth between screens/can you navigate multiple systems.Working knowledge of MS office products – Outlook, MS Word and MS-Excel.Must be able to work 7am - 4 pm CST online/remote