Claims Processor - Team Lead

Job Title: Claims Processor - Team Lead
Location: Phoenix, AZ, 85021, USA
Job Type: Permanent

Job Responsibilities:

  • Assisting with the process of claim adjudication, ensuring that eligibility (including COB), referral/authorizations, and payments are appropriate based on contracts, regulations, industry claim payment standards, and company policies and procedures. Assisting members and providers in the meeting of commercial and/or governmental medical claim and dental reimbursement, representing the company throughout the transaction.
  • Will oversee small group of Medical Claims examiners providing supervisory and lead guidance, and providing performance reviews. Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
  • Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
  • Maintaining external and internal customer relations by interacting with staff regarding claims issues. Providing service as the key contact for clients and working as directed with the clients vendors. Researching and ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information and updating information to claim file with regard to claims status, questions or claim payments.
  • Identifying and referring all claims with potential third party liability, such as subrogation, COB, MVA, stop loss claims and potential stop loss files.
  • Approving, pending, or denying payment according to the accepted coverage guidelines.
  • Assisting in training of new groups and new staff as needed; assisting the management team in problem resolution, planning and overseeing workflows; testing and preparing documentation and updating current documentation; as well as providing suggestions and recommendations to improve workflows and departmental efficiencies.

Qualifications Include:

  • Minimum of five years' related experience in the Healthcare Field
  • Experience on the Payor side strongly preferred. Experience on the Provider side will be reviewed, but candidates must have Supervisory/Team Lead Experience. Experience with or Certification in QicLink preferred. Audit experience preferred.​
  • Knowledge of medical terminology including CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines.
  • Limited travel.

Job Type: Full-time

Experience:

  • Healthcare: 5 years (Required)

Education:

  • High school or equivalent (Required)
Company
Amtec Inc.
Posted
11/06/2021
Salary Range
$23,000.00 - 41,000.00
per Year
Salary range estimated by
Location
Phoenix, AZ 85021, US
Apply Now