Position Summary
The Healthcare Claims Processor is responsible for ensuring the accurate and productive processing of healthcare claims while adhering to regulatory standards. This role involves managing appeals and grievances, ensuring compliance with applicable regulations, and performing quality audits to maintain high standards in claims processing.
Principal Responsibilities
Process healthcare claims according to established guidelines and regulatory requirements.
Manage appeals and grievances from both patients and healthcare providers, ensuring timely and effective resolution.
Conduct thorough quality audits on processed claims to verify accuracy and compliance with Medicare and other relevant regulations.
Collaborate with internal teams to address escalations and enhance workflows associated with claims processing.
Stay informed about changes in healthcare regulations and policies that impact claims processing practices.
Eligibility and Qualifications
Minimum 3 to 5 years of experience in US healthcare systems and claims processing.
Proven experience in handling appeals and grievances effectively.
Knowledge of regulatory compliance standards, particularly those related to Medicare.
Robust analytical abilities complemented by problem-solving skills.
Excellent verbal and written communication skills for effective interactions with patients, providers, and internal staff.
Key Competencies
In-depth understanding of healthcare claims processing within the US system.
Familiarity with grievance handling processes and escalation mechanisms.
Attention to detail to ensure accuracy in all claim-related activities.
Ability to adapt to changes in regulatory requirements efficiently.
Applications will be assessed against the stated requirements outlined above.