Job Description
Claims Processing
Medical Terminology
Description :
- Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
- Verify member eligibility and benefits coverage for submitted claims.
- Evaluate medical documentation to assess the appropriateness of services rendered and coding accuracy.
- Adjudicate claims accurately and efficiently within established turnaround times.
- Identify and investigate potential fraudulent or abusive billing practices.
- Communicate claim decisions, payment details, and denials to providers and members effectively.
- Collaborate with other departments, such as Provider Relations and Customer Service, to resolve claim-related issues and inquiries.
- Maintain comprehensive and organized claim records, documentation.
Requirements :
- Bachelor’s degree in Healthcare Administration, Business, or related field
- Prior experience in healthcare claims processing or medical billing, preferably within an HMO or managed care organization.
- Proficiency in medical terminology, CPT, HCPCS, and ICD-10 coding principles.
- Familiarity with healthcare reimbursement methodologies, such as DRGs, RBRVS, and fee schedules.
- Strong analytical and problem-solving skills with keen attention to detail.
- Excellent communication skills, both verbal and written, with the ability to interact professionally with internal and external stakeholders.
- Proficiency in using computerized claims processing systems and software applications.
- Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment.
Active just now
Preview
Benefits
Health Insurance
Life Insurance
13th Month Pay
Working Location
Sta. Ana Balibago, Angeles. Angeles, Pampanga, Philippines