Claims Assistant

Job Description

REQUIREMENTS

· High school diploma or equivalent.

· Experience with medical claims, preferably with Medicare and Medicaid claims processing.

· Program of All-inclusive Care for the Elderly (PACE) experience a plus.

· Strong understanding of healthcare claims processing and provider relations.

· Excellent verbal and written communication skills.

· Ability to work in a fast-paced environment and handle multiple tasks simultaneously.

· Knowledge of medical terminology and coding systems such as ICD-10, COT, and HCPCS.

· Excellent analytical skills with the ability to assess complex information and make sound decisions.

· Exceptional attention to detail and accuracy in data entry and record-keeping.

· Proficient computer skills, including experience with claim processing software and Microsoft Office applications.

· Effective communication skills, both written and verbal, with the ability to interact professionally with diverse stakeholders.

· Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced environment.

RESPONSIBILITIES

Communication: Correspond with clients, providers, vendors, claims team, and other relevant parties to gather necessary information, clarify details, and provide updates on claim status.

Compliance: Ensure compliance with company policies, industry regulations, and legal requirements throughout the claims processing workflow.

Reporting: Generate reports and statistics on claim processing activities, trends, and outcomes to support claims department, management decision-making and performance evaluation.

Customer Service: Provide courteous and professional assistance to clients and providers, addressing inquiries, concerns, and complaints in a timely and effective manner.

Continuous Improvement: Identify opportunities for process improvement, efficiency gains, and enhanced customer satisfaction within the claims processing function.

Miscellaneous: Assist with projects, reporting, and other duties as requested by management.

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