Job Title: Claims/Benefits Spec
Location: Bellaire, TX - 77401 (Remote or Hybrid)
Duration: 3 Months (Extension Possible)
Duties:- To investigate and accurately process claim appeals within the regulatory requirements mandated by the State of Texas.
- Process Specialists Adjustments, Replacements, Refunds, and Appeals Queues, at 98% average, within 30 days of receipt. (Specialists must process a minimum of 6 claims per hour, per day, annual average).
- Process group queues content at 98% average, within 30 days of receipt.
- Review and process pended claims, within 5 days of initial review.
- Respond to internal inquiries within 48 hours of receipt. Review, investigate and provide accurate and efficient follow-up.
- Ensure Special Projects are completed accurately, in a timely and efficient manner.
- Participates in system testing and reviews for upgrades/implementation.
Skills:- Knowledge of the most recent ICD, CPT/HCPCS coding methodologies (and their successors), as well as general principles with claims processing guidelines
- Strong organizational skills
- Critical thinking
- Detail oriented
- Mathematical aptitude
- Microsoft Office (Word, Excel, etc.)
- Self-motivated & works independently in initiating
Education:
Required: H.S. Diploma or GED
Required: 3 years claims processing experience A Bachelors degree may substitute for the required experience.