Sr Claims Resolution Representative

JOB TITLE: Sr. Claims Resolution Representative
JOB LOCATION: Trenton NJ
WAGE RANGE*: $22hr to $23hr
JOB NUMBER: 24-01133

REQUIRED EXPERIENCE:

o Knowledge of CPT/HCPCS and ICD9 coding procedures and guidelines

JOB DESCRIPTION

This position involves:
o Follows adjudication policies and procedures to ensure proper payment of claims.
o Resolves pending claims based on Medicaid rules and regulation established for final processing.
o Resolves claims resolution and/or adjustments/voids.
o Processes claim adjustments through Reversal/Replacement requests submitted by providers.
o Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
o Meets established production requirements consistently.
o Maintains an accuracy rate of 98% or better.
o Processes financial transactions.
o Review/Resolve LTC Production Reports.
o Data entry of LTC transactions.
o Monitor processing time & unfinished work on a daily basis.
o Process refund/return checks.
o Assist with monthly distribution of LTC TADS.
o Contributes a positive attitude to the team in order to meet department goals.
o Supports all departmental initiatives in improving overall efficiency.
o Assist in monitoring and timely processing of special batches

Requirements
o Basic knowledge of Microsoft Office Outlook, Word and Excel
o General knowledge of PC
o Good working knowledge of medical claims systems
o Knowledge of CPT/HCPCS and ICD9 coding procedures and guidelines
o Mathematical background a plus
o Good verbal and written communication skills
o Ability to abide by Clients policies
o Maintain regular attendance based on agreed-upon schedule
o Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
o Ability to establish and maintain positive and effective working relationships with coworkers, clients, members, providers and customers

Equal Opportunity Employer Veterans/Disabled

* While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions.