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Liverpool, NY - $15.00 to $16.00 per hour Full Time Posted: Monday, 15 April 2019

* Medicare (Part B) Claims Processor is needed for a private medical practice.

Pay scale is $15.00 to $16.00 per hour.

Job Type:

Required Education for the Medicare (Part B) Claims Processor is * High School diploma/GED

Medicare (Part B) Claims Processor Responsibilities: Adjudicate Medicare Part B claims and take appropriate actions to resolve discrepancies.

  • Conduct second-level review of all Medicare denials in addition to commercial denials for Not Authorized and Not A Covered Benefit.
  • Work backlog of denied/rejected claims for timely re-submission.
  • Manage assigned queues keeping up to date and current on all claims and meeting productivity criteria.
  • Obtain necessary documentation and provide the documentation to claims supervisor upon their request.
  • Follow all applicable Medicare and NYS regulations including HIPAA
  • Communication with providers and patients's for claim issue resolution
  • Detail oriented with efficient time management and strong communication skills
  • Assure claim contains pertinent and correct information for processing
  • Confirm member is eligible for coverage on the date(s) of service
  • Confirm services have the required referral/authorization
  • Accurate final claims adjudication/adjustment by using on-line computer claims payment system
  • Research previously processed claims when needed
  • Identify billing patterns, processing errors and/or system issues that inhibit the final adjudication of claims.
  • Adjudicate claims on the EMR system according to guidelines.
  • Calculate DRGs using software package when applicable.
  • Determine ASC groupings when applicable.
  • Determine benefits using automated-system controls, policy guidelines, DFRs, and HMO Fact Sheets.
  • Coordinate and resolve claims issues related to claims processing with the appropriate departments as required.
  • Maintain and follow-up on patient's accounts relating to coordinating of benefits.
  • Research, resolve, and respond to claim re-submission appeals and inquires.
  • Coordinate and resolve claims issues related to claims processing with the appropriate departments as required.

Required Medicare (Part B) Claims Processor Experience:
* A minimum of one year experience in claims-payment adjudication at an IPA, Health Maintenance Organization (HMO) or HP level.
* Possess a working knowledge of CPT codes, ICD-9/ICD-10 codes, Red Book, DRGs, Revenue Codes, HCPC codes and ASC groupings.
* Ability to process all claim types on a CMS 1450 and CMS 1500 claim form, including but not limited to Surgery, Medicine, Lab and Radiology.
* Ability to understand DFRs and benefits.
* Knowledge of CMS and the DMHC rules and regulations.



Liverpool, NY, United States of America
Finance, Healthcare
$15.00 to $16.00 per hour
Click apply
4/15/2019 6:04:49 AM

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