Over 10 years of the insurance industry experience. Strong analytical, documentation and research skills.
• Assist providers with the entry and update of requests for medical clearances
• Research, coordinate and resolve inquiries and claims exceptions
• Coordinate with other Provider Service areas to identify formal education opportunities
• Identify, document and monitor process improvements
•Maintain records, reports, or files
• Moderate to heavy keying required.
• 9+ years' experience in health insurance, provider's office (handling medical coding, filing insurance claims or referrals) or a managed healthcare telephone service center
• Experience working with healthcare products including researching and resolving provider inquiries and working with provider contracts and networks
• Experience working with medical terminology, CPT-4 coding, ICD-9 coding and claims adjudication inquiry resolution processes and procedures
• Experience working with BCBSF healthcare products
*Review contract benefits and approve services for claims payment.
*Examine claim forms and other records to determine insurance coverage
*Verify investigative information
*Maintain insurance records
6-20 All Lines Claims Adjuster
Psychology with Social Welfare Minor
Strong analytical, organization, research, communication and documentation skills.
Submit claims items, document progress of patient throughout care. Create plan of care and document progress until discharge.
Strong writing skills and actively wrote for the college newspaper.
Healthcare: claims authorization, computerized and paper claims submission People skills: advanced problem-solving, great organizational skills
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