Claims Review Specialist
Somerville, MA 02145
Our client in Somerville, MA is looking for a Claims Review Specialist to join their team. In this contract role, you will process claims that do not auto adjudicate through the claims system. Additionally, you will research assigned claims by navigating multiple platforms and accurately capturing the data necessary for processing. If you have two to three years of experience in the healthcare industry in positions such as hospital biller or call center representative, apply today!
Responsibilities Claims Review Specialist:
- Manually enters claims into QNXT as needed.
- Review and research assigned claims by navigating multiple systems and platforms and accurately capturing the data/information necessary for processing
- Ensure that the proper benefits are applied to each claim
- Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately
- Keep up to date with Desktop Procedures
- Identify and escalate system issues, configuration issues, pricing issues etc. in a timely manner
- Process member reimbursement requests as needed
Requirements for the Claims Review Specialist:
- High school diploma or equivalent
- Two to Three years of experience in the healthcare industry in functions such as hospital or physician biller or call center representative
- Knowledge of ICD-10, HCPCS, CPT-4, and revenue codes
- Technology savvy with a strong knowledge working with Microsoft Office
- Strong organizational skills with great attention to detail
- Strong multi-tasking and prioritizing skills with the ability to meet deadlines
- Excellent written and verbal communication skills
- Strong interpersonal skills with a customer service focus
- Must be eligible to work in the U.S. without sponsorship
- Contract Employee Benefits:
- Health and Dental
- Contract employees are eligible for subsidized health and dental insurance coverage upon completion of 120 hours on assignment within four (4) consecutive weeks working a minimum of thirty (30) hours per week.
- Paid Sick Leave
- Contract employees who are employed to work in the Commonwealth of MA may accrue and use up to forty (40) hours of paid sick leave per calendar year in increments of no less than one (1) hour.
- 401(k) Plan
- Regularly recruited contract employees, who are U.S. citizens aged twenty-one (21) or older, are eligible to contribute to KNF&T’ s retirement savings plan with Fidelity Investments.
- Short Term Disability
- Contract employees are eligible for subsidized short term disability, covering up to 12 weeks of a disability including maternity leave.
- Free Training
- KNF&T uses a state of the art e-Learning software training system. We encourage all our contractors to take advantage of this training, which is available 24 hours a day, 7 days a week.