Correct Care Solutions Medical Claims Processor in Hendersonville, Tennessee

Overview

Our Claims Processor will review and adjudicate claims verifying eligibility, approval of services, and accurate pricing.

Qualifications

Education:

  • Must have high school diploma or GED

Experience:

  • One (1) year of medical claim billing experience with knowledge of CPT4 and ICD10 codes or One (1) year of medical claims processing.

Licenses/Certifications:

  • None required

Responsibilities

  1. Completes accurate analysis of claim determination for payment or denial based on established rules and processes.

  2. Monitor claim inventory of assigned accounts and ensure turnaround and productivity benchmarks are met.

  3. Processes claims from returned pended claims reports and those containing claim edits.

  4. Manually prices claims based on specific rates.

  5. Audit peer’s work for continued cross training and education.

  6. Follow-up on provider calls on status, explanation of payment, billing errors, and refund requests.

  7. Communicate to Claims Leadership any issues that would impede the accurate and timely processing of claims.

  8. Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.

  9. Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.

  10. Must be alert at all times; pay close attention to details.

  11. Must be able to work under stress on a regular or continuous basis.

  12. Perform other duties as assigned.

CCS is an EOE/Minorities/Females/Vet/Disability Employer

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Job 18-54640

Location TN, Hendersonville

Facility Health Cost Solutions

Type Regular Full-Time

Shift Day

Recruiter Jennifer Bates

Email JCBates@CorrectCareSolutions.com