Claims Processor

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

APPLY HERE