Job ID: J114690
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Screens, reviews, evaluate online entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appropriately. Convert foreign currency to US dollar and code charges appropriately. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Takes the corrective action steps using enrollment, benefit and historical claim processing information.
1.Determine if claim information is complete and correct. Enter/verify claims data.
2.Resolve claim edits, review history records and determine benefit eligibility for service. Review payment levels to arrive at final payment determination.
3.Meets all production and quality standards. Attends all required training classes.
4.Elevates issues to next level of supervision, as appropriate.
5.Maintains accurate records, including timekeeping records.
6.Other duties as assigned or requested.
Knowledge, Skills and Abilities
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