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Claims Representative in Troy at Collabera

Date Posted: 9/18/2018

Job Snapshot

  • Employee Type:
    Contractor
  • Location:
    Troy
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    9/18/2018

Job Description

Industry Healthcare
Work Location Troy, MI
Job Title Claims Representative
Duration 6 months
• Resolves Provider Reconsideration Requests (PRR) from providers relating to claims payment and requests for claim adjustments.
• Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error.
Essential Functions:
• Handles written response to incoming reconsideration requests from providers and outside agencies.
• Enters provider demographic and contract affiliation information into the health plan system.
• Composes correspondence to reflect accurate resolution information in a clear, concise, grammatically correct format.
• Maintains tracking system of correspondence and outcomes of request; maintain organized and accurate files.
• Communicates with Provider Service Representatives regarding relevant provider issue
Knowledge/Skills/Abilities:
• Knowledge of medical terminology, claims coding guidelines, and Provider Contracts
• Comprehensive knowledge of healthcare customer service
• Good MS Office knowledge (Outlook, Word, and Excel)

Required Experience:
• Experience in a managed care setting. CPT and ICD-9 coding, data entry.

Job Requirements

Claims verification
CPT and ICD-9 coding