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Medical Claims Processor
3 weeks ago
Job Description
This Medical Claims Processor role requires excellent organizational and analytical skills to review patient clinical documentation and communicate with payers to obtain necessary approvals.
Key Responsibilities:
- Review patient's clinical and chart documentation related to the service submitted by the provider's office
- Communicate with payers to obtain necessary approvals
- Respond to payer's clinical questions to proceed with authorization and referral requests
- Cater inbound calls from payers and perform necessary actions required for the task
Requirements:
- Solid understanding of anatomy & physiology, including how body systems function and an understanding of disease processes
- Comprehensive understanding of Medical Terminology
- Prior experience in processing multispecialty authorizations including contact with payers
- 2 years experience of acute hospital experience
- Experience in prior authorization process
- Excellent communication skills: clear and concise
- Strong problem-solving skills
- Ability to work well under pressure
Education and Experience:
- Graduate of Bachelor of Science in Nursing with active PH registered nurse license
- 1–2 years of experience in business process outsourcing preferably
