Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.
Timely response and resolution of claims received via emails as priority work
Correctly calculate claims payable amount using applicable methodology/ fee schedule
Requirements
3 year(s) hands-on experience in Healthcare Claims Processing
In-depth, hands-on, practiced experience processing COB claims
Demonstrated experience with institutional and professional claims
2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools
High school diploma or GED.
Previously performing remote - in P&Q work environment; work from queue
Key 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 (training is required on-camera).
Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities
Time management with the ability to cope in a complex, changing environment
Ability to communicate (oral/written) effectively in a professional office setting
Additional Instructions
Processing of Professional claim forms files by provider
Reviewing the policies and benefits
Comply with company regulations regarding HIPAA, confidentiality, and PHI
Abide with the timelines to complete compliance training of NTT Data/Client
Work independently to research, review and act on the claims
Prioritize work and adjudicate claims as per turnaround time/SLAs
Ensure claims are adjudicated as per clients defined workflows, guidelines
Sustaining and meeting the client productivity/quality targets to avoid penalties
Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.
Timely response and resolution of claims received via emails as priority work
Correctly calculate claims payable amount using applicable methodology/ fee schedule
