Employer: Arcadia Healthcare Solutions
Why This Role Is Important To Arcadia
The Claims Processor role is responsible for claims processing, reviewing, auditing and investigation of high-level coding review and processing discrepancies. Average number of claims entered weekly 800-1100, depending on level of difficult claims being worked that week.
What Success Looks Like
In 3 months
- Familiar with basic navigation in the Eldorado processing system
- HCFA and UB92 Workflow Queues in Eldorado System
- HCFA and UB92 Pended Claims and Exception Reports
- Auditing weekly reports
In 6 months
- Review and Finalize 095 report of claims sent to BCBS needing MG review and status of approval
- Working special projects
- Familiar with BlueCross portals
- Familiar with internal portals, MCG, Arcadia share point, Appeal Module
- Processing the minimum requirement of 20 claims per hour
In 12 months
- Assist with other coworker’s workflow when assigned client based primary responsibilities are caught up
- Meeting and maintaining production expectations 23-27 claims per hour on commercial accounts
- Meeting and maintaining production expectations 18-22 claims per hour on Medicare Advantage
- Meeting quality expectations of an average of 95% or higher
- Full understanding of Eldorado system
What You’ll Be Doing
- HCFA and UB92 Pended Claims and Exception Reports
- HCFA and UB92 Workflow Queues in Eldorado System
- Audit Reports such as possible duplicates, timely filing review
- Work special reports such as Anesthesia, Mental Health, etc.
- Review and Finalize claims appeals received by providers/members
- Review Pre-payment audit reports
- Review and Finalize 095 report of claims sent to BCBS needing MG review and status of approval.
- Assist with other coworker’s workflow when assigned client based primary responsibilities are caught up.
What You’ll Need to Have
- High School diploma or equivalent
- 1 -3 years medical claims adjudication experience (HMO claims preferred)
- Proficiency in Microsoft Office Applications, high Excel proficiency
- Excellent verbal and written communication skills
- Good attention to detail and commitment to quality
- Positive mental attitude
- Ability to multi-task
- Deadline oriented
- Ability to work independently with minimal supervision
Would Love for You to Have
- Coding certification
- Excel
- Access
What You’ll Get
- Join a high performing team who brings all data into one of the top Healthcare Analytics companies in the US
- Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
- A flexible, remote friendly company with personality and heart
- Employee driven programs and initiatives for personal and professional development
- Be a member of the Arcadian and Barkadian Community
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