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Healthcare Claims Examiner:

Company: Cognizant US Corporation
Location: Phoenix
Posted on: November 11, 2019

Job Description:

Healthcare Claims Examiner: Healthcare Claims Examiner: Seeking candidates with experience in Claims Processing. Professionals with healthcare background preferred. Training will be provided (2 - 3 weeks). PURPOSE: Processing basic payments and/or claim denials for group health which includes medical, dental, vision, FSA, HSA, HRA and disability benefits; demonstrating the highest levels of customer service, technical skills and professionalism. ESSENTIAL FUNCTIONS: Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met. Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit. Approving, pending, or denying payment according to the accepted coverage guidelines. Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met. Processing complex claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit. Approving, pending, or denying payment according to the accepted coverage guidelines. Knowledge of HIPAA regulations and healthcare administration functions, including claims processing, eligibility verification, provider verification and preauthorization desirable. ESSENTIAL SKILLS: QUALIFICATIONS: Critical thinking Time Management Work Independantly Effective Communicator Strong attention to detail Technical aptitude Analytical High School diploma or GED required 2-3 years Claims processing or directly related work experience. Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required. Must have FACETS exp Must have Medicare knowledge 0 % Application Development / Application Maintenance United States-Arizona-Phoenix - AZ USA, CLT Full Time Employee Full-time Standard Professional Day Job Oct 30, 2019, 4:46:32 PM Business Process Outsourcing BPO - United States

Keywords: Cognizant US Corporation, Phoenix , Healthcare Claims Examiner:, Healthcare , Phoenix, Arizona

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