What are the responsibilities and job description for the Processor IV position at 1199SEIU Benefit and Pension Funds?
Requisition #:
6750-6751
# of openings:
2
Employment Type
Full time
Position Status
Permanent
Category
Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Non-Exempt
Responsibilities
6750-6751
# of openings:
2
Employment Type
Full time
Position Status
Permanent
Category
Bargaining
Workplace Arrangement
Hybrid
Fund
1199SEIU National Benefit Fund
Job Classification
Non-Exempt
Responsibilities
- Review suspense reason of medical claims and determine actions to be taken to handle edit
- Verify information entered in medical claims system (QNXT) is correct, including patient’s name, provider tax identification number and suffix, diagnosis and procedure codes
- Access medical claim image and other reference materials as appropriate
- Apply contractual benefits, medical policy, and operational procedures to finalize claim
- Handle adjustments and reversals of previously paid medical claims as necessary
- Review and handle call tracking tickets as assigned
- Research eligibility issues in Vitech (V3)
- Review and handle EOBs as assigned
- Research and complete request refund form
- Complete medical inquiry form for Medical Consultant
- Handle complex edits and manual pricing
- Perform additional duties and projects as assigned by management
- High School Diploma or GED required, some college or degree preferred
- Minimum of two (2) years’ experience examining and resolving medical claims in a health insurance or benefits environment required
- Thorough knowledge of medical claims processing including major medical, office visits, surgery, anesthesia, lab and x-rays required
- Knowledge of eligibility systems including Coordination of Benefits (COB) and Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits required
- Excellent oral and written communication skills
- Demonstrated organizational skills with ability to multi-task and follow up
- Good problem-solving skills with ability to work independently and as a team player
- Ability to work independently and as a team player
- Excellent data entry skills with a minimum 6,000 KPH and 6% or less error rate required
- Must meet performance standards including attendance and punctuality