"Alerted.org

In this Role the candidate will be responsible for:

+ Processing of Professional claim forms files by provider

+ Reviewing the policies and benefits

+ Comply with company regulations regarding HIPAA, confidentiality, and PHI

+ Abide with the timelines to complete compliance training of NTT Data/Client

+ Work independently to research, review and act on the claims

+ Prioritize work and adjudicate claims as per turnaround time/SLAs

+ Ensure claims are adjudicated as per clients defined workflows, guidelines

+ Sustaining and meeting the client productivity/quality targets to avoid penalties

+ Maintaining and sustaining quality scores above 98.5% PA and 99.75% FA.

+ Timely response and resolution of claims received via emails as priority work

+ Correctly calculate claims payable amount using applicable methodology/ fee schedule

Requirements:

+ 1-3 year(s) hands-on experience in Healthcare Claims Processing

+ 2+ year(s) using a computer with Windows applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools

+ High school diploma or GED.

+ Previously performing – in P&Q work environment; work from queue; remotely

+ Key board skills and computer familiarity –

+ Toggling back and forth between screens/can you navigate multiple systems.

+ Working knowledge of MS office products – Outlook, MS Word and MS-Excel.

+ Must be able to work 7am - 4 pm CST online/remote