AP CLAIMS PROCESSOR

The Accounts Payable - Claims Processor will ensure that claims (both paper and electronic) received from providers are processed and adjudicated correctly based on organizational policies and processes. This position will ensure accurate Medicare and contract payment billing rates with providers. This process will include frequent communication with providers to resolve any issues. Once the claims submission has been adjudicated, the claim will be processed through the accounts payable system.

Essential Functions:
1. Follow procedures to pay, return, or deny claims. Prepares the draft for payment and verifies that payment has been made.
2. Reviews and resolves discrepancies in a timely manner.
3. Establishes a working relationship with billing providers, members, and internal staff.
4. Rejects or accepts authorization documentation, determines benefit due, and starts the denial or payment process to resolve medical claims.
5. Contacts billing providers and IDT (interdisciplinary) teams to correct claim authorizations so that claim billings can be properly processed.
6. Researches and processes claims according to business regulations, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes.
7. Resolves system edits, audits, and claims errors through research and use of approved references and investigative sources.
8. Coordinates with internal departments to work edits and deferrals, updating the patient identification, health insurance, provider identification, and other files as necessary.
9. Pays all properly adjudicated claims.
10. Maintains claims files.
11. Records 1099 form at each calendar year.
12. Other duties as assigned.
 

Education: High School Graduate (Required). BA/BS degree (Preferred).

Experience: Experience in accounts payables and/or claims processing (Preferred)

Specific skills/abilities:
• Excellent computer skills and experience in the Microsoft Office Suite
• Excellent organizational and time management
• Strong communication skills and the ability to work with various internal and external
parties to process claims and billing issues.
• Detail oriented
• Interpersonal skills
• Data entry skills
• Capability to manage confidential and proprietary information.