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Claims Representative II/III (...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Miami, FL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4412

Claims Representative II/III (Health and Dental) - Miami, FL (PS4412)

About the Job

Description
Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Claims Representative II

The incumbent will be responsible for processing various types of claims, system generated edits, adjustments, and be able to interpret and apply all applicable policy, procedures, and guidelines. Must be able to successfully perform all the duties of a Claims Rep I. In addition, must work without significant guidance w/basic understanding of multiple products (HMO, Medicare, Medicaid, COB, etc.). Ability to work well under pressure.    

 

Primary duties may include, but are not limited to:

  • Ability to work in a quality production environment; meets and/or exceed individual/department productivity and quality standards, goals, and objectives.
  • Must demonstrate working knowledge of all product lines Medicare, Medicaid, and COB.
  • Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regs, coordination of benefits, & healthcare terminology.
  • Works closely with claims mgmt. staff on special or priority cases.
  • Reviews, completes, and makes corrections to the daily mass, while ensuring that claims are processed in accordance to claims policy and procedures and payment guidelines.
  • Responsible for working overtime hours as requested by the Company.

Claims Representative III

The incumbent will be responsible for assigning ICD-10 CM, CPT-4, and HCPCS codes as appropriate to narrative diagnosis and procedures documented in the medical record and encounter form. In addition, will be accountable with working system generated edits for both professional and facility claims, adjustments, special projects, and be able to interpret and apply all applicable policy, procedures, and guidelines. Must be able to successfully perform all the duties of a Claims Rep II.    

 

Primary duties may include, but are not limited to:

  • Ability to work in a quality production environment; meets and/or exceed individual/department productivity and quality standards, goals, and objectives.
  • Must demonstrate working knowledge of all product lines Medicare and Medicaid.
  • Expertise in reviewing and assigning accurate medical codes for diagnosis, procedures, and services performed by physicians and other qualified healthcare providers in the office or facility setting.
  • Proficiency across a wide range of services, including evaluation and management, anesthesia, surgery, radiology, pathology, and medicine.
  • A sound knowledge of medical codding guidelines and regulations including compliance and reimbursement.  
  • Possess an appropriate sense of urgency and actively seeks to understand internal and external customer problems, expectations and needs.
  • Ability to work well under pressure and manage conflict in an effective and positive manner.
  • Ability to interact with QNXT claims system, review and finalize all edit messages, and report any usual system related issues.
  • Responsible for working overtime hours as requested by the Company.

Qualifications

Qualifications

Claims Representative II

  • HS diploma or GED
  • 2-3 years of claims processing experience in a Managed Care and/or Indemnity environment preferred.
  • Working knowledge of Procedure Codes (e.g. CPT), Diagnosis Codes (ICD-10) and pricing information based on product line.
  • Must type 45 wp
  • Knowledge of CMS 1500 and UB04 form(s)
  • Prior experience with an online claims adjudication processing system (QNXT, FACETS, or other) experience is preferred.
  • MACESS workflow system experience is preferred

Claims Representative III

  • Must be certified in medical billing coding.   
  • 3-5 years of claims processing experience in a Managed Care and/or Indemnity environment preferred.
  • Working knowledge of Medical Terminology and have excellent organization and time management skills, preferred.
  • Must type 45-60 wpm
  • Prior experience with an online claims adjudication processing system (QNXT, FACETS, or other) experience is preferred.

    Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

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