Overview of Responsibilities
This is a long term opportunity to grow with one of the largest health insurance companies in the Twin Cities! This is an opportunity for any experienced person with a medical coding or billing background, who is searching for a long term opportunity with the potential to work from home one day a week after two months of perfect attendance and fantastic work! This requires that individuals have an up to date certified professional coding (CPC) certificate.
The Claims Processor IV is the expert resource in terms of claims coding, system capabilities, recommended system application and the implementation of benefits and reimbursement policies for all business segments. They provide coding expertise to claims processors, internal customers on the policies administrated by HealthRules or iCES. They collaborate and consult with the Coding Consultants, Auditors, Claims Management Teams and the Operations Analysts at UHG to ensure proper system implementations and claims processing.
This individual will be responsible for reviewing and processing complex provider appeals and will serve as the first point of contact 'expert' for claims coding and processing issues related to HealthRules, iCES, deductible/out-of pocket accumulators, provider claims histories, check void/replacement, based on a variety of inter and intra-departmental needs. In addition, the Claims Processor IV will assist in the training and auditing of new hires and will serve as a 'tester and auditor' for new HealthRules enhancements. The Claims Processor IV is expected to provide recommendations for claims enhancements or process improvements for claims processing.
The Claims Processor IV is also responsible for reviewing Policy and Procedure documents to ensure they are current and accurately reflect claims processing requirements. This person works with managers within Operations as well as I.T., Payment Intent, Network Management, Internal Audit, and Finance related to claims processing or implementation of new products or system enhancements.
3-5 Must have skills/qualifications
- CPC (Certified Professional Coder Certification (Use within last 2 years**)
- Medical Claims Processing Experience
- Knowledge of HealthRules Policies
Top Performer Profile
- Knowledge of Medica Products
- 4+ Years of Medical Coding
- 3+ Years of Claims Processing
4 + Years of Medical Coding
Schedule & Hours On Site
8:00 - 5:00 / 8:30 - 5:30 M-F
Certifications/License: MUST be a Certified professional coder (CPC certified)