Claims Processing Specialist

Job Overview:

The Claims Processing Representative is responsible for the processing of provider electronic and paper claims in compliance with the NYS DOH and Prompt Pay Law. Claims Processing Representative will also provide information, education and customer service to Hamaspik Choice providers as necessary regarding the process of claims/ billing and any status inquiries.

Essential Responsibilities:

• Examine, process, adjudicate and prepare claims for payment ensuring receipt of the necessary supporting documentation; in compliance with the NYS DOH, Prompt Pay Law and MLTCP benefit coverage guidelines
• Comply and remain up to date with state laws, policy and company procedures
• Assist providers with issues or inquiries regarding their claims and/or policies
• Enter codes and verify data for computer processing
• Prepare EOPs for payment of claims and verify that payments have been made
• Follow up and respond to identified items requiring attention
• Scan and file paper claims for record keeping

·         Participate in mandatory meetings as necessary.

• Other duties as identified as a necessary part of employee’s role

 Specific Knowledge, Skills, and Abilities:

·         Proficient in the use of office equipment and the computer; Microsoft Word and Excel.

·         Self-directing, good organizational and interpersonal skills.

·         Demonstrates good customer skills on telephone