Process new claims or modifies existing claims according to the appropriate and applicable action Analyze claims to determine appropriate action to approve or deny a claim for payment Determine accurate payment criteria for clearing pending claims based on defined policies and procedures Research claims edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for entry-level claims Reviewing and addressing provider inquiries regarding claim adjudication, and other Claims matters Assist and/or communicate with providers to fully understand issues and complexities of claims cases Demonstrate ability to work on high volume of repetitive claims Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards Ready to work on a fast-paced learning process and highly engaged to complete all claims cases assigned

Education and experience:

Bachelor’s Degree holder preferably in the field of Nursing, Healthcare and Allied Medical Profession Minimum of 2 years of experience in medical claims processing experience Knowledge in medical coding, diagnosis coding and terminologies an advantage but not required

Skillset:

Proficient knowledge on US Healthcare Practice, Medical Coding (ICD-10, CPT4, DRG, HCPCS), Clinical Documentation Improvement, medical terminologies, EDI, and HIPAA protocols are a must Ability to multi-task and follow documented claims processes with minimal supervision Excellent verbal and written business communication skills Proficiency in Windows OS and Microsoft Office applications, particularly in Excel Strong attention to detail and the ability to make appropriate decisions based on information presented