Processor IV

Job description

Qualifications: - Review suspense reason of medical claims and determine actions to be taken to handle edit - Verify information entered in Medical claims system (QNXT) is correct, including patient’s name, provider tax identification number and suffix, diagnosis and procedure codes - Access medical claim image and other reference materials as appropriate - Apply contractual benefits, medical policy, and operational procedures to finalize claim - Handle adjustments and reversals of previously paid medical claims as necessary - Review and handle call tracking tickets as assigned - Research eligibility issues in Vitech (V3) - Review and handle EOBs as assigned - Research and complete request refund form - Complete medical inquiry form for Medical Consultant - Handle complex edits and manual pricing - Perform additional duties and projects as assigned by management - High School Diploma or GED required, some college or degree preferred - Minimum of two (2) years’ experience examining and resolving medical claims in a health insurance or benefits environment required - Thorough knowledge of medical claims processing including major medical, office visits, surgery, anesthesia, lab and x...