Claims Specialist II

POSITION SUMMARY:  The Level 2 Claims Specialist position is a mid-level Specialist position.  The Specialist will provide timely and accurate processing of health insurance claims for various types of services. This will include researching authorizations, working with the provider contracting staff as necessary, managing pended claims in a timely manner, and maintaining all related work materials in a manner compliant with HIPAA regulations. 

 

ESSENTIAL DUTIES: Attend scheduled meetings and training sessions as assignedAccept assignments from management and maintain open communications with their Team Leader to resolve any quality or production issue.Meet the established production standards and the quality standards for the Level 2 position.  Work cooperatively with all levels of employees within the claims unit and within Bravo Health.Process all types of claims and identify key elements and processing requirements based on diagnosis, provider, medical policy, contracts, and policies and procedures. Efficiently and accurately processes claims utilizing broad based product or system knowledge to ensure timely payments are generated. as assigned by the supervisory team.  

 EDUCATION:

· High school diploma or General Education Degree (GED) required

· Two years of college preferred or at least 2 years of experience CERTIFICATION/LICENSURE: N/A

 

EXPERIENCE:

§ Knowledge of benefits and standard claims processing rules.

§ Minimum of two years claims processing experience, and the knowledge to recognize the data elements necessary for an accurate submission of a claim.

§ Knowledge of CPT, HCPC, Revenue, and ICD9 Coding

§ Minimum of three years experience in health care.

§ Excellent organizational and analytical experience required

§ Ability to meet deadlines and manage multiple priorities

§ Effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environment

§ Ability to handle confidential information with professional ethics and integrity

§ Good to excellent mathematical aptitude

 COMPUTER SKILLS: Working knowledge and proficiency with Microsoft Office including WORD and Outlook.Excellent data entry skills requiredDatabase software knowledge highly preferredAbility to be flexible and acquire new skills in working with other internal computer systems.

 

COMMUNICATION SKILLS:Strong oral and written communication skillsStrong interpersonal skills and ability to effectively communicate with team members, and other departmental staffProfessional telephone etiquette.   

PROBLEM SOLVING ABILITY:

· Position requires research skills and the ability to analyze data to be able to identify a problem and to determine the necessary steps to resolve the issue.

 

DECISION MAKING SKILLS:

· Makes decisions on what needs to be done based on clearly established guidelines.

 

SUPERSIORY SKILLS:  N/A

 PHYSICAL DEMANDS:  · Ability to sit at workstation for extended periods, using computer keyboard and visual display terminal Ability to lift 25 pounds.Able to work overtime when needed /assigned to meet critical deadlines.