Claims Examiner
Company: Baylor Scott & White Health
Location: Temple
Posted on: February 22, 2021
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Job Description:
JOB SUMMARYThe Claims Examiner is responsible for claims
processing, research and adjudication to correctly apply benefit
determinations on routine medical claims (CMS 1500 and UB04) and Rx
claims in accordance with claims processing guidelines.ESSENTIAL
FUNCTIONS OF THE ROLEProcesses and adjusts routine professional,
facility and Rx claims according to claims processing guidelines.
Pends claims as directed by departmental policies and procedures,
follows up for resolution, and processes pended claims immediately
following a benefit / payment determination. Maintains
confidentiality rules in compliance with HIPPA guidelines.Works
claims inventory from assigned queues to ensure all claims are
processed within established turnaround time as directed by
department policies and procedures. Focuses on achieving
departmental and organizations objectives.Reviews all output
reports to ensure accurate benefit and rider determinations.
Completes reports to ensure prompt payment of claims.Identifies and
reviews systematic or procedural problems with management for
timely follow-up and correction. Consistently meets/exceeds
productivity standards and accuracy standards for payment,
procedural and financial.Performs follow-up and takes all necessary
actions required to resolve errors and findings assessed by the
Quality Review Team.KEY SUCCESS FACTORSAble to understand and apply
basic policies, practices, and procedures.Good written and verbal
communication skills with an emphasis on confidentiality, tact and
diplomacy.Good organizational and analytical skills; demonstrated
ability to manage multiple tasks simultaneously.Intermediate
proficiency and experience using Microsoft Office (Excel, Access,
PowerPoint and Word).Superlative customer service skills.May be
required to work in excess of regular scheduled hours.
BENEFITSOur competitive benefits package includes the following-
Immediate eligibility for health and welfare benefits- 401(k)
savings plan with dollar-for-dollar match up to 5%- Tuition
Reimbursement- PTO accrual beginning Day 1 Note: Benefits may vary
based upon position type and/or levelQUALIFICATIONS- EDUCATION -
H.S. Diploma/GED Equivalent- EXPERIENCE - Less than 1 Year of
Experience
Keywords: Baylor Scott & White Health, Temple , Claims Examiner, Other , Temple, Texas
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