Claims Analyst - Vital Job at MMM Holdings
LE0006 MSO of Puerto Rico, LLC
It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Examine and validate electronic and paper claims, including adjustments, C.O.B. and M.S.P. claims in a timely and accurate manner.
- Prepare claims until its validation process for providers and members, on denial or adjusted claims.
- Research and document results of claims; either for special consideration, conditions or additional data.
- Interface with personnel of the different areas of the Department to ensure the resolution of problems around the claims, such as, correct validation, and timely payment services.
- Assign Non Plan Providers to existent claims.
- Report any problem that may affect the claims process.
- Alert a Claims Supervisor for all situations on the System that affect a complete processing cycle of claims.
- Comply with established quality metrics and production targets.
- Special projects could be assigned.
- Participate with the Claims Supervisors in the preparation of recommendations or guidelines oriented to approach the resolution of claims patterns. Also, participates in the research, validation and resolution of claims new pattern.
EDUCATION AND EXPERIENCE
-
Associates degree (A.A) or equivalent of two year college or technical school or minimum 2 year equivalent experience in claims processing.
-
Medical Billing course, preferably
-
Experience in CPT-4, ICD-10, HCPCS, CMS-1500 Form, UB-04
-
Knowledge in Medicaid regulations (COB/MSP)
LANGUAGE SKILLS
Bilingual. Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
REASONING ABILITY
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
INTERPERSONAL RELATIONS
The responsibilities of this position require continuous interaction with colleagues.
Internal Contacts
Managers Supervisors Internal MMM departments
External Contacts
Providers
SKILLS AND ABILITIES
Bilingual (English – Spanish) desirable Oral and Written Communication skills Effective interpersonal communication Ability to operate various types of office equipment including software packages such as Office – Word, Excel and Power Point – 2000 and Outlook – and database familiarity a plus. Self- directed with good organizational skills
PHYSICAL AND MENTAL DEMANDS
The position requires sitting, standing and walking associated with a normal office environment, talking and hearing. This position requires weight to be lifted or force to be exerted up to 10 pound.
ENVIRONMENTAL AND WORKING CONDITIONS
While working the employee is exposed to a general normal office environment. Employee may work occasional evening or weekend work. The noise in the work environment is moderate.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
I acknowledge receipt and review of this job description and understand that it is subject to change.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
Please Note :
clarksqn.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, clarksqn.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.