Claims Processor II / Job Req 805617986

Remote: Full Time must live in one of 6 states where we operate: CA, AZ, NV, TX, WA,OR. Available for Full-Time Work Schedule 8:00am - 5pm Pacific Time, Monday-Friday.

Principal responsibilities include:

• Research claims for completion and appropriateness.
• Review and handle rejected claims as necessary.
• Evaluate HealthSuite error screen and base payment determination using AAH claims processing guidelines.
• Utilize Claims Department policies & procedures, workflows, and manuals to meet Departmental production and quality metrics.
• Routinely exceed established Departmental individual production standards and collaborate with other Claims staff to ensure departmental compliance targets are met. The current production standard for this position is a minimum average of 17 claims per hour.
• Meet or exceed a financial and procedural accuracy standard of 97%.
• Review routine and moderately complex claims and edits to determine the appropriate handling for each including paying, denying, or suspending for Claims Processor II or Supervisor review.
• Manually price claims as needed.
• Communicate identified issues with claims and claims processes to Supervisor or Manager.
• Actively participate and collaborate with the entire department to continuously improve workflows and performance.
• Perform other duties and special projects as assigned.

• Process claims of a routine and more complex type using the claims processing system.
• Review and analyze claims for routing to appropriate queues for resolution.
• Routinely exceed Departmental performance and quality metrics.
• Comply with AAH's Code of Conduct, and all regulatory requirements

• Constant and close visual work at desk or computer.
• Constant sitting and working at a desk.
• Constant data entry using keyboard and/or mouse.
• Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 20 lbs.

• Knowledge of CPT, HCPCS, ICD-10 and revenue codes.
• Knowledge of CMS1500 and UB04 forms and fields.
• Experience with processing Medi-Cal or Medicaid program claims preferred.
• Experience in RAM HealthSuite a plus.
• Ability to work in cooperation with others.
• Ability to communicate effectively, both verbally and in writing.
• Ability to handle multiple projects simultaneously and balance priorities.
• Experience in the use of Microsoft Office software (Outlook, Word, Excel).