Processes and adjudicates healthcare claims accurately and promptly according to payment policies and contractual agreements. Resolves claim edits and suspended claims, manually prices claims using various tools, maintains reference materials, reviews updates, and collaborates with Quality and leadership on complex claims. Provides backup support to team members while following procedures, regulatory requirements, and internal controls.
Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.
Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
Demonstrated basic analytical skills.
Basic written/oral communication skills.
Demonstrated reading comprehension and ability to follow provided directions.
- Adjudicates claims and adjustments as required.
- Resolves claims edits and suspended claims.
- Maintains and updates required reference materials to adjudicate claims.
- Provides backup support to other team/group members in the performance of job duties as assigned.
- Manually prices claims with various tools and processes to pay the claims.
- Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.
- Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.
Other Job Requirements
Responsibilities
Demonstrated ability to navigate computer applications.Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
Demonstrated basic analytical skills.
Basic written/oral communication skills.
Demonstrated reading comprehension and ability to follow provided directions.
General Job Information
Title
Claims Processor IIGrade
19Work Experience - Required
ClaimsWork Experience - Preferred
Education - Required
GED, High SchoolEducation - Preferred
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$37,725Salary Maximum:
$56,595This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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