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Medical Claims Processor

L.K. Jordan & Associates

This is a Contract position in Sunset Valley, TX posted August 17, 2021.

Medical Claims Processor wanted in Sunset Valley

On-Site Class starts August 16th so apply today!

Monday-Friday
1st shift

Summary/Objective:
The support role is expected to assist with medical cases, as well as coordinate document storage, data integrity and data transfer processes. The role is required to know the membership types, current guidelines and any department policies to ensure consistent business practices.

Essential Duties:

  • Review and determine eligibility for member cases ( appeals, reimbursements, maternity, advanced opinion).
  • Ensure medical needs are mapped correctly to the provider and member. Map manually if needed.
  • Ensure that all medical needs are being tracked on the files when importing or exporting data to carriers or vendors.
  • Ensure all records are reviewed, tasks are completed, and open issues are resolved for medical review.
  • Proactively communicate potential issues to management to allow for timely resolution.
  • Locate and correct data entry errors or report them to supervisors.
  • Compile, sort, and verify the accuracy of data before it is entered.
  • Compare data with source documents, or re-enter data in verification format to detect errors.
  • Work on various projects to ensure member information and medical need information is accurate and up to date.
  • Provide support with other tasks as necessary, which may be assigned by management.

Skills Required:

  • Critical thinking and problem-solving skills
  • Self-motivated, goal-oriented individual
  • Excellent written, verbal, and interpersonal communication skills
  • Work independently and in a team environment
  • Strong computer skills and working knowledge of Microsoft Outlook
  • Ability to comprehend medical records at a basic level

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

  • Experience with medical policies and procedures, HIPAA, claims processing required
  • Healthcare experience required
  • High School Diploma is required

Technical Knowledge:

  • Microsoft Office Suite including Excel, Email and Internet
  • Medical billing and coding knowledge preferred
  • Salesforce knowledge preferable

To apply please email resume to alejandra.Lopez@lkjordan.Com

Call 512-342-0307 to schedule your interview today!

LKJordan is an Equal Opportunity Employer

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