Claims Examiner
Company: MetroPlus Health Plan
Location: Chester
Posted on: May 14, 2022
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Job Description:
Empower. Unite. Care. MetroPlusHealth is committed to empowering
New Yorkers by uniting communities through care. We believe that
Health care is a right, not a privilege. If you have compassion and
a collaborative spirit, work with us. You can come to work being
proud of what you do every day.
About NYC Health + Hospitals MetroPlus Health Plan provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest
public health system in the United States, MetroPlus' network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlus has been
committed to building strong relationships with its members and
providers to enable New Yorkers to live their healthiest life.
Position Overview
This position is responsible for the data entry and system
adjudication of provider claims. The incumbent authorizes final
disposition of claims within prescribed guidelines in an accurate
and timely manner.
Job Description Process claims involving medical and/or surgical
services; screens for complete member/provider information.
Applies administrative policies when necessary, utilizing the
claims processing manuals.
Authorizes the generation of letters/questionnaires to providers to
obtain additional information.
Reviews descriptions of services on claims to determine validity of
charges of the presence of errors.
Evaluates and examines claims pended by the system due to
contractual and/or payment discrepancies.
Maintains production and quality goals established for the
department.
Performs other related duties, i.e., maintaining individual
production counts, updating manuals and reference materials,
attending all refresher training seminars.
Minimum Qualifications Associates Degree or any combination of
education/experience.
Minimum 2 years experience in the healthcare insurance industry
with -knowledge of integrated claims processing.
Proficient Data Entry Skills.
Through knowledge of medical terminology, CPT, ICD-p, and Revenue
Codes.
Professional Competencies
Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication
Keywords: MetroPlus Health Plan, Paterson , Claims Examiner, Other , Chester, New Jersey
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