Claims Adjuster II
The Claims Adjuster II is responsible for the accurate and timely processing of pended claims of moderate complexity received by the Claims Department. The Claims Adjuster II is also responsible for communicating with internal staff, vendors, providers, and billing representatives on the outcome of claims processed as well as the status of outstanding claims.
location: Glen Allen, Virginia
job type: Contract
salary: $15 - 18 per hour
work hours: 8 to 5
education: High School
experience: 2 Years
- Process pended claims accurately and within the time frames established by
- Management and Contractual Agreements using the claims document imaging system and the claims processing system.
- Manually enter in un-scannable paper claims in the claims processing system
- Complete ChangeGear tickets assigned within established time frames
- Master a thorough understanding of such claim types as Nursing Facility, Home Health, and EDCD Waiver services
- Master a thorough understanding of such items as HCPC and Procedure codes, modifiers and their effect on reimbursement, appropriate billing guidelines for anesthesia claims, dialysis, durable medical equipment (DME), and home health services.
- Work claims reports as directed by management
- Work as a unit/team in resolving claims issues or special projects
- Report any inconsistencies that are identified in regards to internal department policies and procedures or potential billing issues to Management
- Work with Management to ensure that all existing workloads have been addressed and are within acceptable time frames
- The ability to provide phone coverage for Claims Customer Service
- The ability to work overtime as needed
- Perform other duties as assigned
- Experience to IDX and QNXT claims processing systems
- Strong organizational, written, and verbal skills
- Exposure to health care environment and knowledge of CMS 1500 and UB04 Claim forms
- CPT-4 and ICD9/ICD10 knowledge
- Ability to work independently and in a team environment
- Ability to meet deadlines and work under pressure in a Production based-Goal oriented environment
- Minimum two (2) years claims processing/healthcare billing experience
If you feel like you would be good fit for this opportunity please send your updated resume to Samantha.Johnson@Randstadusa.com!
skills: Medical Billing, Insurance Claim Processing
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.