Claims Processor - Pampanga - 18K Salary

CLAIMS PROCESSOR – 1

( Angeles City Pampanga Office)
Work Schedule: 8:30am-5:30pm
Salary Offer: 18, 000

Responsibilities:
? Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual
agreements and regulatory guidelines.
? Verify member eligibility and benefits coverage for submitted claims.
? Evaluate medical documentation to assess the appropriateness of services rendered and coding
accuracy.
? Adjudicate claims accurately and efficiently within established turnaround times.
? Identify and investigate potential fraudulent or abusive billing practices.
? Communicate claim decisions, payment details, and denials to providers and members effectively.
? Collaborate with other departments, such as Provider Relations and Customer Service, to resolve
claim-related issues and inquiries.
? Maintain comprehensive and organized claim records, documentation.

Job Qualifications/Specifications:
? Bachelor's degree in Healthcare Administration, Business, or related field
? Prior experience in healthcare claims processing or medical billing, preferably within an HMO or
managed care organization.
? Proficiency in medical terminology, CPT, HCPCS, and ICD-10 coding principles.
? Familiarity with healthcare reimbursement methodologies, such as DRGs, RBRVS, and fee schedules.
? Strong analytical and problem-solving skills with keen attention to detail.
? Excellent communication skills, both verbal and written, with the ability to interact professionally
with internal and external stakeholders.
? Proficiency in using computerized claims processing systems and software applications.
? Ability to prioritize tasks, manage workload efficiently, and meet deadlines in a fast-paced
environment.