Claims Adjudicator

AXIA Health Management is in the business of helping people live healthier lives. Through engaging programs, we motivate people to make positive lifestyle changes and accomplish goals they never thought possible. We help people increase their level of physical activity. We help people lose weight. We help them quit smoking. And we provide different paths to better health, including access to whole health methods and treatments. Come join us in changing the world’s focus from health to healthy!We are seeking a Claims Adjudicator will review claims for completeness and validity based on verification of eligibility and interpretation of contract benefits and process accordingly.
REQUIREMENTS
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-(i.e. 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 (i.e. explanation codes, denial codes, pricing structure, accumulators, system overrides)
•Reprocess claims when necessary
•Document subscriber, provider and group files when appropriate for audit trail
•Provide support to internal departments
•Assist internal associates with claims related questions and issues
•Identify reoccurring problems and provide feedback to management to effect change
•Conduct claim specific research to resolve outstanding provider issues
•Research claim issues to identify root cause and determine corrective action to resolve issue, communicate findings, document findings for future use
•Perform claims adjustments on claims incorrectly adjudicatedOur ideal candidate will possess:
•Two or more years of prior experience in health insurance claims processing•Medicare claims experience preferred
•High school diploma or equivalent
•1 to 2 years of claim processing experience in HCFA 1500 and UB92s
•Strong analytical and problem solving skills
•Excellent communication skills (oral, written, and presentation)
•Ability to manage workflow and meet deadlines on a consistent basis
•Ability to use Microsoft Office software proficiently
•Individual must possess proven organizational and interpersonal skills
•Individual must possess the ability to collaborate with others and work effectively within a team environment
•Knowledge of medical terminology required
•Ability to interpret varied insurance contracts, both member and provider
•Ability to work independently and as part of a team to accomplish unit goals
•Ability to handle varied workload
•Knowledge of ICD-9 coding, CPT codingDoes this sound like the opportunity for you? If so, please submit your resume and salary history to [Click here for email]