Claims Processor

Work at Home
Immediate

Job Description

Grow with a company that is passionate about helping you maximize your full potential! Become a part of transforming customer and client experience through the utilization of our innovative work from home technology. At BroadPath we believe in assuming the highest intention for others, our employees are empowered through their voices. BroadPath is thrilled to be hiring Claims Processors! Claims Processors will review and process medical and hospital claims, which include specialty services, emergency room visits, in-patient and out-patient claims for services rendered.

Responsibilities

  • Review claims for billing, coding accuracy and completeness. 
  • Process in accordance to all Plan, Federal and State provisions. 
  • Evaluate claims for and report out suspected fraud, waste and abuse. 
  • Use enterprise claims processing platform and ancillary supporting data bases and systems to research and/or retrieve key information necessary to support claims processing. 
  • Meet or exceed productivity and quality expectations as detailed in the Claims Department Performance Plan. 
  • Represent and demonstrate a thorough knowledge of both medical and hospital claims billing requirements, regulatory guidelines and the Plan Benefits applicable to each of the Affinity Health Plan product lines of business. 
  • Identify problems or questionable claim situations, resolve issues where appropriate, and refer to Claims Resolution Specialist for guidance. 
  • Generate letters requesting additional information required to support proper claim determinations as well as denial letters to providers and Members as deemed appropriate. 
  • Work cooperatively with Staff throughout the company and contribute to the overall success of the Claims Department. 
  • Prepare weekly/monthly reports of claims activity, tracking claims processed against performance plan goal. Complete and submit all reports or other documentation required by Management, in a timely manner. 
  • Perform other duties as necessary or required.

Basic Qualifications

  • Prior Facets Experience is required 
  • Knowledge of Medical Claim Forms 
  • Strong knowledge of Medicaid guidelines and policies
  • Knowledge of coding (ICD-9, ICD-10, HCPCS, CPT)
  • IT technical savvy– Ability to work with multiple tools on a computer at the same time, and do so with ease
  • Strong written and verbal communication skills, analytical, strong systems aptitude 
  • Strongly prefer candidates with prior successful work at home experience – Will consider stand out candidates with no prior work at home experience

Preferred Qualifications

  • High school diploma or GED; Associates Degree preferred. 
  • Previous experience in a Medicaid managed care environment with a minimum of one year of claims processing experience preferred.  
  • Strong keyboard skills preferred (ability to accurately process 45+ wpm) 
  • Experience processing claims in enterprise managed care data base systems, ideally Facets claims processing. 
  • Strong analytical, organizational, problem solving and prioritization skills. 
  • The ability to work independently, proactively and function well under pressure. 
  • Ability to successfully organize work and effectively manage claim volume. 
  • Ability to communicate clearly and effectively, both verbally and in writing. 
  • Basic proficiency with Microsoft Office (Word, Excel, Power Point, etc.) including data entry skills and experience. 
  • Claims platform experience.