Job Title : Claims Resolution Representative

Location : Onsite at Hamilton Township, NJ 08619

Duration : 12 Months (Contract to Hire / possible of extension)

Job Description :

Looking for candidates as Claims Resolution Representative who can resolve customer issues in the areas of claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures and has knowledge of CPT / HCPCS and ICD9 coding procedures and guidelines.

Responsibilities :

This position involves :

• Follows adjudication policies and procedures to ensure proper payment of claims.
• Resolves pending claims based on Medicaid rules and regulation established for final processing.
• Resolves claims resolution and / or adjustments / voids.
• Processes claim adjustments through Reversal / Replacement requests submitted by providers.
• Prices claims manually as required by Medicaid rules and system limitations as defined by policy and departmental procedures.
• Meets established production requirements consistently.
• Maintains an accuracy rate of 98% or better.
• Processes financial transactions.
• Review / Resolve LTC Production Reports.
• Data entry of LTC transactions.

o Monitor processing time & unfinished work on a daily basis.

• Process refund / return checks.
• Assist with monthly distribution of LTC TADS.
• Contributes a positive attitude to the team in order to meet department goals.
• Assist in monitoring and timely processing of special batches

Experience :

• Basic knowledge of Microsoft Office Outlook, Word and Excel
• General knowledge of PC
• Good working knowledge of medical claims systems
• Knowledge of CPT / HCPCS and ICD9 coding procedures and guidelines
• Mathematical background a plus

Skills :

• Good verbal and written communication skills
• Ability to abide by client policies
• Maintain regular attendance based on agreed-upon schedule
• Maintain confidentiality and comply with Health Insurance Portability and

Accountability Act (HIPAA)

Ability to establish and maintain positive and effective working relationships with

coworkers, clients, members, providers and customers

Education :

• High school diploma or G.E.D. Relevant coursework.

Last updated : 2024-05-29