Company :Highmark Inc.
Job Description :
Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
E1. Validate Claims: * Verify data by reviewing, correcting, deleting or re-entering data in required fields as identified by the claims software – (Kofax Transformation Module – KTM) * Complete validation in each KTM module: Document Review, Pre-Validation and Regular Validation as required * Resolve claim edits and discrepancies by using standard operating procedures desk levels and business rules as required for specific claim related processing procedures * Complete return letters for incomplete, invalid or missing claim information to providers or members utilizing the appropriate application and/or template * Electronically route claim questions to the appropriate queue for clarification, explanation or resolution * Prepares non-standard subscriber claim submissions for data entry (ie: foreign, or cruise ship claims) * Review and code non-standard provider claim submissions for data entry (ie: Medicare and subrogation claims)
E2. Indexes documents – Completes required data entry in specific identified fields to connect claim related documents for further processing.
E3. Achieve and maintain an acceptable level of productivity, quality and/or other established department measures.
E4. Must maintain confidentiality and adhere to HIPAA regulations.
E5. Communicate in a professional, polite and respectful manner.
E6. Perform other duties of a similar nature that are not inconsistent with this position.
Required Education: HS/GED
Required Experience: Preference given to candidates with previous claims coding experience. Preferred experience with Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes.
1. Must meet qualifications to perform the job including satisfactory completion of all training and testing
2. Alphanumeric Data Entry test with minimum of 9,000 KPH
3. Successful completion of Claims Coder/Keyer Job Content test
4. Basic Computer Literacy skills test
5. Ability to multitask in fast paced environment
6. Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
7. Ability to effectively communicate with others in the department in a professional manner
8. Working knowledge of personal computer and application software
9. Ability to utilize basic office equipment including PC, copier, printer
10. Computer Software typically used and proficiency level: SunGard / Kofax
Resolves problems through utilization of desk level instructions and communication
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Other Job Specifications:
External Contacts: N/A
Working Conditions/Physical Demands:
* Must be able to work in an office environment
* Physical Effort: Minimum; typical of most office work. Mostly sedentary work.
* Weight: lift/carry/push/pull under 10 lbs.
* Prolonged Sitting
* Repetitive Motion
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Vision Req: Close vision (clear vision at 20 inches or less)
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )
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