Claims Processor III

Versant Health•Baltimore, MD

20h•$21

About The Position

The Claims Processor III role is responsible for processing claims in the CompuVision/CVX system(s) and supports claims routing and handling in the MACESS Claims Management System workflows. The position is also responsible for incoming paper claims received for processing to include entering data in Formworks using the three modules (OCR, KFI, and KE) to pass claims to the MACESS Claim Management System and/or CompuVision/CVX. The role handles assigned claims-related inventories including but not limited to claim adjustments, claims reconciliations, and claim issue research/resolution. All established production and quality metrics must be met when completing assigned responsibilities.

Requirements

Minimum High School Diploma or GED
One year of claims experience required
Knowledge of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes required
Proficiency in Microsoft Office
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Responsibilities

Performs data entry and verification of incoming paper claims
Processes all claim submissions for adjudication and payment
Research and resolves claim discrepancies utilizing business knowledge, training, and internal guidelines
Supports other departments concerning claims related questions
Meets required performance guarantee deadlines, company objectives and production and quality standards
Adheres to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA)
Participates in training and educational activities necessary to meet the requirements of the position to include production and quality standards and department goals
Completes any activities necessary for the maintenance of professional affiliations or organizational requirements
Regular reliable attendance is required
Other duties as assigned