Join to apply for the Hospital Claims Processor V role at 1199SEIU Benefit and Pension Funds
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Join to apply for the Hospital Claims Processor V role at 1199SEIU Benefit and Pension Funds
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- Review hospital claims and determine action needed to resolve pended claims
- Process and evaluate hospital claims manually or through claims work flow
- Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies
- Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures
- Review, finalize and respond to call tracking tickets in a timely manner to provider inquires
- Perform additional duties and special projects as assigned by management
Requisition #: 7107-7110 # of openings: 6 Employment Type Full time Position Status Permanent Category Bargaining Workplace Arrangement Hybrid Fund 1199SEIU National Benefit Fund Job Classification Non-Exempt Responsibilities
- Review hospital claims and determine action needed to resolve pended claims
- Process and evaluate hospital claims manually or through claims work flow
- Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies
- Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures
- Review, finalize and respond to call tracking tickets in a timely manner to provider inquires
- Perform additional duties and special projects as assigned by management
Qualifications
- High School Diploma or GED required, some College or Degree preferred
- Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required
- Basic keyboarding skills required
- Strong 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) codes
- Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments
- Able to work well independently and in a team environment
- Ability to meet strict deadlines, work well under pressure and in a fast-paced environment
- Must meet performance standards including attendance and punctuality
Seniority level
- Seniority level Entry level
Employment type
- Employment type Full-time
Job function
- Job function Other
- Industries Hospitals and Health Care
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