Medical Claims Processor
POSITION SUMMARY:
NEW TITLE (RRT Analyst) will be responsible for the handling of adjustments received from various departments timely. Examine claim calculations for adjustment and claimant’s history to determine accuracy.
ESSENTIAL FUNCTIONS:
• Handling of repricing adjustments.
• Group exception referrals.
• Work with other claim department personnel when necessary to determine appropriateness of RRT referral.
• RX refunds and analysis.
• Tracking and handling of projects.
• Accumulator updates.
• Recalculation of claims due to accumulator updates.
• Other duties as assigned.
EDUCATION:
• High School diploma or equivalent required
EXPERIENCE AND SKILLS:
• Minimum of 3 years medical claims processing experience required.
• Experience with the QicLink claims processing system preferred.
• Applicant should be proficient in the use of the Excel and Word programs, have experience with or ability to learn Microsoft Access.
• Ability to communicate effectively both orally and by email.
POSITION COMPETENCIES:
• Job Knowledge
• Time Management
• Accountability
• Communication
• Initiative
• Customer Focus
PHYSICAL DEMANDS:
• This is a standard desk role – long periods of sitting and working on a computer are required.
WORK ENVIROMENT:
• Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
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NEW TITLE (RRT Analyst) will be responsible for the handling of adjustments received from various departments timely. Examine claim calculations for adjustment and claimant’s history to determine accuracy.
ESSENTIAL FUNCTIONS:
• Handling of repricing adjustments.
• Group exception referrals.
• Work with other claim department personnel when necessary to determine appropriateness of RRT referral.
• RX refunds and analysis.
• Tracking and handling of projects.
• Accumulator updates.
• Recalculation of claims due to accumulator updates.
• Other duties as assigned.
EDUCATION:
• High School diploma or equivalent required
EXPERIENCE AND SKILLS:
• Minimum of 3 years medical claims processing experience required.
• Experience with the QicLink claims processing system preferred.
• Applicant should be proficient in the use of the Excel and Word programs, have experience with or ability to learn Microsoft Access.
• Ability to communicate effectively both orally and by email.
POSITION COMPETENCIES:
• Job Knowledge
• Time Management
• Accountability
• Communication
• Initiative
• Customer Focus
PHYSICAL DEMANDS:
• This is a standard desk role – long periods of sitting and working on a computer are required.
WORK ENVIROMENT:
• Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
Apply tot his job
Apply To this Job