Claims Review Specialist - Accounting

Must have High school diploma, GED or equivalent required, Two year degree preferred.

Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization.

Minimum of 2 years previous direct experience that included verifying and maintaining provider information and provider contract configuration in a managed care transaction system.

REQUIRED EXPERIENCE:

High school diploma, GED or equivalent required, Two year degree preferred.

Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization.

Minimum of 2 years previous direct experience that included verifying and maintaining provider information and provider contract configuration in a managed care transaction system.

Working knowledge of one or more of the following managed care transaction systems: EPIC (Tapestry Module), EZ Cap, Facets, QNXT.

Working knowledge of CPT-4, ICD-9/ICD-10, and HCPCS codes.

Must have the ability to interpret a variety of instructions furnished in written, oral, diagram and schedule form including provider contracts and contract summaries.

Ability to adhere to detailed data entry procedures in a complex Managed Care Transaction System with high accuracy for alpha and numeric data inputting.

Strong organizational skills and the ability to manage aggressive timelines and prioritize multiple concurrent tasks while maintaining high quality standards.

Proficient computer skills including Microsoft Excel and Word. Competence in navigating the internet.

Excellent customer service and interpersonal skills, with an ability to work with internal and external representatives

Willingness to learn new technologies, practices and procedures