Hospital Claims Processor V

Job TitleResponsibilities:Review hospital claims and determine action needed to resolve pended claimsProcess and evaluate hospital claims manually or through claims work flowValidate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepanciesFinalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational proceduresReview, finalize and respond to call tracking tickets in a timely manner to provider inquiresPerform additional duties and special projects as assigned by managementQualifications:High School Diploma or GED required, some College or Degree preferredMinimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment requiredBasic keyboarding skills requiredStrong 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) codesDemonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignmentsAble to work well independently and in a team environmentAbility to meet strict deadlines, work well under pressure and in a fast-paced environmentMust meet performance standards including attendance and punctuality