This job has expired.
Employment Type:
Full time
Shift:
Day Shift
Description:
Reporting to the Operations Manager, the Claims Specialist will be responsible for processing both professional and facility medical claims.
Position location is Westmont, Illinois
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Responsible for responding to and timely investigation / resolution of all inquiries received on designated customer service lines in accordance with policies and procedures.
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Analyze claims and approve or deny claims for payment by ensuring the fees are correct, verifying the proper authorizations were submitted, and resolving hold codes. Ensure the validity of claims by reviewing claim forms and attached documentation, verifying the accuracy of information entered into the claims processing application, and reviewing claims for potential secondary-coverage issues. Ensure claims are processed timely in accordance with the HMO and CMS guidelines.
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Recommend opportunities for decreasing claims-related customer service calls by reporting any trends to LPP management.
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Maintain all necessary levels of member / patient privacy in accordance with HIPAA standards which includes identify any caller requesting PHI before disclosing information, ensure proper authorization has been received, and provide limited information only on a "need to know" basis.
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Minimum Education:
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Required: High School Diploma
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Preferred: Associate Degree
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Required: 1-3 years of previous job-related experience
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Preferred: 4+ years of previous job-related experience
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Details: One year experience processing medical claims or related experience (billing). One year of Customer Service experience. Familiarity with managed care products. EZ Cap experience preferred. Knowledgeable in different types of claims and the standard claim processing procedures
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
This job has expired.
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