Easter Seals Jobs

Description:

PURPOSE: Under direct supervision reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures. ESSENTIAL FUNCTIONS: 60 Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy contracts policies and procedures allowing timely considerations to be generated using multiple systems. 25 Completes research of procedures. Applies training materials correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions. 10 Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling quality improvement initiatives workflow design and financial planning etc. 5 Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions. Qualifications To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Level: High School Diploma or GED Experience: less than one year experience processing claim documents Preferred Qualifications 1-3 years Claims processing billing or medical terminology experience Knowledge Skills and Abilities KSAs Demonstrated analytical skills Proficient Demonstrated reading comprehension and ability to follow directions provided Proficient Basic written/oral communication skills Proficient Demonstrated ability to navigate computer applications Proficient The incumbent is required to immediately disclose any debarment exclusion or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities deadlines and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer including customers who may be demanding or otherwise challenging.

Experience Level:

Entry Level

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.