Medical Claims Processor
Solxsys Administrative Solutions, LLC
is looking for a Medical Claims Processor to work in our Kansas City Office.
This is Not a Remote position.
GENERAL DUTIES AND RESPONSIBILITIES including but not limited to:
- Review claims for benefit determination based on work queue, electronic or hard copy submissions.
- Make corrections when necessary to incorrect Participant or Provider data when authorized.
- Assist Member Service Representatives with difficult claim issues.
- Primary responsibilities will not include telephone or personal interaction with participants or providers unless; it is determined by a supervisor or manager that assistance is needed in this area.
- 2-3 Years of Claims Processing experience
- Coordinator must be able to determine benefits for multiple groups and process claims accurately according to the corresponding Plan Documents.
- Coordinator will be expected to process X number of claims (based on Plan complexity) and maintain an accuracy rate of 98% procedure and 99% financial.
- Ability to read, write and speak Spanish is preferred, but not required
- Medical terminology classes, knowledge of medical billing and codes ICD9 and CPT coding is a plus.
- Trizetto facets experience a plus