$15.90 - $18.50 hourly
Tivity Health
Remote (USA)
The Claims Processor/Adjudicator will review claims for completeness and validity based on verification of eligibility and interpretation of contract benefits and process accordingly. Essential Duties and Responsibilities:
Review claims for correct internal data entry and make necessary changes.
Review claims for correct provider coding information regarding appropriateness of reported services and billing practices.
Request additional information needed to complete adjudication of claim-e.g., records and/or x-rays, clarification of submitted billing information.
Review claims for necessity, limitations and exclusions based on claim policies and procedures.
Determine and enter appropriate benefit/adjudication coding based on subscriber’s plan benefits-e.g. explanation codes, denial codes, pricing structure, accumulators, system overrides.
Document subscriber, provider and group files when appropriate for audit trail.
Assist internal associates with...