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16 days old

Claims Examiner I

Kelly Services
Temple, TX 76504
Kelly Services is hiring a Claim Examiner I at a Healthcare Facility in Temple, Texas.


JOB SUMMARY: The Claim Examiner I is responsible for claims processing, research and adjudication to correctly apply benefit determinations on routine uncomplicated medical claims (CMS 1500 and UB04) and Rx claims in accordance with claim processing guidelines,


WHAT IS EXPECTED (ESSENTIAL FUNCTIONS):


+ Processes and adjusts uncomplicated professional and facility and Rxclaims according to claims processing guidelines

+ Pends claims as directed by departmental policies and procedures, follows up for resolution and process pended claims immediately following a benefit / payment determination

+ Works claims inventory from assigned queues to ensure all claims process within established turnaround time as directed by department policy and procedures

+ Reviews all output reports to ensure accurate benefit and rider determinations

+ Completes reports to ensure prompt payment of claims Coordinates win-scanning of claims related documents into members MACESS folder

+ Identifies and review problems systematic or procedural with Supervisor for timely follow-up and correction

+ Consistently meet /exceed productivity standards and accuracy standards for payment, procedural and financial

+ Performs follow-up and takes all necessary actions required to resolve all errors and findings assessed by the Quality Review Team Performs task individually and as part of an assigned team

+ Maintains confidentiality regarding rules around HIPPA guidelines

+ Performs additional duties as assigned

+ May be required to work in excess of regular scheduled hours

+ Focuses on achieving departmental and organizations objectives

+ Complies with company policies and procedures, which includes punctuality as they relate to work time, lunch, and break period


KNOWLEDGE, SKILLS, AND ABILITIES:


+ High school diploma or equivalent (GED)Associate degree preferred 1 year experience preferred

+ Medical claims processing strongly preferred

+ Medical terminology, CPT, HCPCS, ICD9, ICD10, and coding preferred

+ Demonstrates effective data entry skills; ability to navigate within a computer / systems-without assistance Experience in a windows- based computer environment

+ Excellent verbal and written communication skills

+ Excellent attention to detail

+ Excellent analytical and problem solving skills

+ Ability to prioritize and work within time frames to accomplish tasks

+ Excellent organizational skills


Minimum Requirements:


+ Minimum Exp: preferred 6 months Claims Processing

+ HS Degree required

+ Proficient in Excel (filter, search, hyperlink, etc), Teams, Outlook & we will train them on specialized systems.

+ They will need a basic understanding of Claims Processing

+ They will be going to the Austin office to pick up their equipment and stay the first day or two

+ Pay Rate Max: $18.56/hr


**Why Kelly** **** **?**


Youre looking to keep your career moving onward and upward, and were here to help you do just that. Our financial staffing experts will connect you with premier companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in in your career. It all adds up.


**About Kelly** ****


At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/nontraditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live (plus, did we mention we provide a ton of benefits ?). Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.


Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.
Posted: 2021-09-06 Expires: 2021-10-07

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Claims Examiner I

Kelly Services
Temple, TX 76504

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