Claims Processor - Remote / Telecommute - Cynet Systems : Job Details

Responsibilities:

• Examine and resolve non-adjudicated claims to identify key elements of processing requirements based on contracts, policies, and procedures.
• Process product or system-specific claims to ensure timely payments, calculate deductibles and maximums, and research and resolve pending claims.
• Use automated system processes to send pending claims for accurate completion according to medical policy and procedures.
• Complete research of procedures using training materials, correspondence, and medical policies to ensure accurate claim processing.
• Partner with the Quality team for procedure clarity or difficult claims and receive coaching from leadership.
• Participate in ongoing developmental training to perform daily functions.
• Complete daily productivity data used by leadership to compile performance statistics for scheduling, quality improvement, workflow design, and financial planning.
• Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

• High School Diploma or GED.
• Less than one year of experience processing claim documents.

• 13 years of experience in claims processing, billing, or medical terminology.
• Demonstrated analytical skills.
• Strong reading comprehension and ability to follow directions.
• Basic written and oral communication skills.
• Ability to navigate computer applications.
• Ability to work effectively in a fast-paced environment with changing priorities and deadlines.
• Ability to meet deadlines and manage multiple customer service demands.
• Strong customer service skills when interacting with internal and external customers, including those with challenging needs.
• Must disclose any debarment or ineligibility related to Federal health care programs.