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Medical Claims Examiner

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Workforce Opportunity Services (WOS) launches technology and business careers for recent college graduates and military veterans. We partner with corporations throughout the United States to open up full-time, entry level career pathways. If you are struggling to get your foot in the door, we can help you navigate your first steps. Our employees receive personalized mentoring and a benefits package to ensure their continued success.

For more information about WOS, visit our website: Workforce Opportunity Services

This is a consultancy role with the potential to hire with our partner NASCO. NASCO provides claims processing solutions for national, state, large group, small group, and individual and government programs. NASCO’s core strength comes from our claims processing system, which is unsurpassed in the market for dependability, flexibility, scalability and operational performance. We also offer a highly configurable membership solution that can be suited for any Plan’s total book of business, as well as a multitude of performance-based services designed to help our Plan customers improve their operational efficiencies and reduce costs.

Overall Position Description:
Under general supervision and guidance, the Claims Examiner is responsible for the initial examining, coding and input of claims and referrals into various processing systems. In addition, duties may include pending claim resolution and claim adjustments.

Responsibilities:

  • Data entry of primary and secondary claims, as well as referrals/authorizations into various processing systems
  • Activate claim batches through the batch activation screen in the data entry application
  • Follow Plan documented processes for entering claims into the data entry application Follow NASCO/Plan documented processes for processing claims in EEC (electronic error correction) in the NPS (NASCO Processing System)
  • Follow NASCO/Plan documented processes for Initiating and processing claim adjustments in the NPS
  • Review claims to ensure proper information is on each claim to complete processing
  • Translate narrative descriptions into proper; i.e. ICD10 codes, HCPCS (Healthcare Common Procedure Coding System), CPT (Current Procedural Terminology), Revenue codes, Diagnostic codes, NDC (National Drug Code)
  • Follow NASCO/Plan documented processes for resolving system edits in the data entry application and EEC on the NPS
  • Follow Plan documented processes for returning claims with unidentifiable information back to healthcare professional/subscriber
  • Ensure timely and accurate payment or denial of claims and adjustments
  • Document any additional information or specific action taken while processing claims and adjustments using the Plan’s worksheet document application
  • Perform general clerical duties to ensure accurate disposition of claims/referrals that cannot be entered into the various processing systems.
  • Perform other related duties as required by Management.

Qualifications:

  • Required Knowledge/Skills/Abilities
    • High School Diploma or GED equivalent required
    • Excellent oral and written communication skills
    • Must be a motivated, self-starter, with high initiative and sense of urgency, and have a high attention to detail.
    • Proven ability to work well in a stressful environment, interact in a team environment and foster positive attitudes
    • The ability to perform basic arithmetical calculations
    • The ability to read, understand, interpret and follow written direction
    • The ability to accurately perceive detailed information, including verbal and numerical material.
    • The ability to code information correctly
  • Preferred Knowledge/Skills/Abilities
    • Some knowledge of health insurance industry.
    • Some experience with medical terminology, as well as billing and coding.
    • Knowledge of multiple systems, strong PC skills, typing skills of 40 wpm without errors. - Needs to demonstrate willingness to be cross-trained in other roles/duties.
    • Organizational, multi-tasking, and strong Interpersonal Skills
    • Ability to communicate with all levels of customers.
    • At least 1 (one) year of clerical business experience.
    • Experience working in a production and quality environment.

Duration:

  • Full-Time (40 Hours/Week)(7:30AM-4:30PM)

Salary:

  • $12.00/Hour (Plus Benefits)

Location:

  • Sandy Springs, GA