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Assistant Claim Specialist

Freshers years
Not Disclosed
10 Nov. 25, 2024
Job Description
Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

position-summary

The Assistant Claim Specialist is an entry-level position for claim processing. This role involves reviewing, analyzing, and making decisions regarding the payment, partial payment, or denial of medical and dental claims, as well as other invoices, based on knowledge of each client’s customized plans.

essential-functions

  • Process Medical and Dental claims and invoices using the QicLink system.
  • Analyze and ensure compliance with clients’ customized plans.
  • Adhere to privacy and security laws such as HIPAA and HITECH.
  • Independently review claims for reasonableness of cost, unnecessary treatment, and fraud.
  • Review and analyze billed procedure and diagnosis codes for billing irregularities.
  • Ensure claims are processed for medical necessity and billing inconsistencies.
  • Authorize payments, partial payments, or denials based on claims investigation.
  • Manage claim pends and suspends, finalizing all claim determinations in a timely manner.
  • Provide support to other Claim Specialists when requested.
  • Attend continuing education, including HIPAA training.

education

  • High School Graduate or equivalent.
  • Continuing education required for group health and welfare plans.

experience-skills

  • Minimum of two (2) years of medical claims analysis experience (excluding Medicare/Medicaid).
  • Preferred experience with Third-party Administrators.
  • Knowledge of CPT and ICD-10 coding.
  • Strong analytical skills and computer systems knowledge.
  • Desire to support the Team in exceeding established goals.
  • Prior dental and vision processing experience is preferred but not required.

competencies

  • Job Knowledge
  • Time Management
  • Accountability
  • Communication
  • Initiative
  • Customer Focus

physical-demands

  • Office setting with the ability to sit for extended periods.

work-environment

  • Remote position.