Hospital Claims Processor V

Responsibilities

Review hospital claims and determine action needed to resolve pended claims Process and evaluate hospital claims manually or through claims work flow Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures Review, finalize and respond to call tracking tickets in a timely manner to provider inquires Perform additional duties and special projects as assigned by management Qualifications High School Diploma or GED required, some College or Degree preferred Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required Basic keyboarding skills required Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT) Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments Able to work well independently and in a team environment Ability to meet strict deadlines, work well under pressure and in a fast-paced environment Must meet performance standards including attendance and punctuality