What are the responsibilities and job description for the Hybrid CSR-Processor position at WM MICHAEL STEMLER INC?
Delta Health Systems, one of the leading Third Party Administrators (TPA) for self insured programs in the country with a reputation for flexibility, innovative services and outstanding customer service is looking for an innovative, self motivated, dedicated individual to fill the position of:
Claims Processor / Customer Service Rep.
POSITION RESPONSIBILITIES
- Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy and Department guidelines
- Key all final information for claims release into computer
- Respond to telephone customer inquiries verifying eligibility, explaining coverage, quoting benefits and advising on the status of claims
- Maintain information files, worksheet records, benefit quote documentation
- Establish and maintain COB files, applies COB payments for final claim payment
- Research and determine proper CPT procedure and ICD-9 Diagnosis Codes
- Research and respond to written correspondence from participants, providers, and local unions/employers
- Prepare transmittal and send claims to Benefit Review for processing instructions
- Work effectively to achieve acceptable production and accuracy standards
- Display maturity, composure and ability to operate under stress conditions
- Perform other duties as assigned
- Specialty duties include: Enter dates of service on dental pre-determinations. Process voided checks and refund checks. Maintain weekly disability files and process claims.
KNOWLEDGE AND SKILL
Eighteen (18) months experience as a Claims Processor or similar function. Must have a broad knowledge of medical terminology and must possess excellent written and oral communication skills. Must possess good judgment skills and ability to interpret Department guidelines and contractual benefits and possess a high school diploma or equivalent. Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience.
Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package.
Equal Opportunity Employer
Qualifications:
Delta Health Systems is committed to long-term growth, employee development and superior client service. Join a great team with terrific total comp package.
Equal Opportunity Employer
Salary : $20