Elite Technical is seeking several Healthcare Claims Processors! The selected candidate will review and process 200-300 paper/electronic healthcare claims within our client's FACETS platforms.

ESSENTIAL FUNCTIONS:
- 55% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
- 25% Does extensive research of procedures. May also apply training materials, emails and medical policy to ensure claims are processed correctly. Utilizes the quality team for assistance on unclear procedures and/or difficult claims and receives coaching from leadership. Ongoing developmental training to performing daily functions.
- 10% Completes productivity data daily that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.
- 10% Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.

Required Skills

- Education Level: High School Diploma or GED is required
- Experience: 3 years of Healthcare Claims processing knowledge
- Must have FACETS experience (Legacy and Sixth generation (G6))
- Must have experience working in high volume claims processing environment (200-300 daily)
- Knowledge of Medical terminology: Diagnosis codes (CPT/ICD) knowledge is required
- SW Tools: MS Office (Outlook, Excel, MS Teams, SharePoint, .PDF)
- Must have worked with HealthEdge's GuidingCare platform
- Basic knowledge of Transaction Insight (TI) and SIR (Stored Information Retrieval)