Transguard WorkforceSolutions is currently recruiting for a Medical Claims Processorfor a client in the healthcare industry.
As a Medical ClaimsProcessor, you will evaluate more complex data entry, clerical, andaccounting tasks involved in the preparation and processing ofpatient insurance claims.
In this role, your responsibilities willinclude the following :
Ensuring thatinsurance claims information is entered into the system correctly,to ensure accurate processing and timely payment.
Ensuring that provider’s fees andservice items charges coincide with their existing contract pricelist of the company.
Ensuring theaccuracy of the entered data as per the existing standard steps andprocedures of direct claims processing.
Comparing data on claims applications andscreening claim documents and processing claimadjustments.
Ensuring payment ordersare properly created and forwarded accordingly for finaldocumentation and filing.
Acting as areference person for information on enquiries concerning claimsprocessing procedures.
Monitoringcorrect application of beneficiary share accordingly on serviceitems billed.
Ensuring the claims areproperly audited of all data entered with accurate medical claimsdetails.
Providing requisition ofoffice supplies for individual and team requirement.
Researching claims as needed.
Obtaining audit medical records to compute andrecord patient charges.
The idealcandidate will have the following skills and experience :
Medical background preferred.
At least 2 years of filing / documentationexperience.
Experience within thehealth care industry; TPAs, insurance companies, hospitals, medicalcenters is a plus.