Claims Processor I

Innovage Denver , CO 80208

Posted 2 weeks ago

Job Summary

Under the Supervision of the Claims Manager, the Claims Processor I is responsible for various administrative, customer service and claims processing tasks aimed to ensure the accurate and timely processing of UB, HCFA and Dental claims submitted by external providers for participant care. This position interacts with Innovage's providers, third party vendors, and all levels of internal personnel.

Essential Functions and Work Responsibilities

Functional Category: Claims Administration

Estimated Percent of time Spent

  • 100%
  • Print and reconcile all mail received via department e-mail and fax, ensuring all claims printed are clean and are forwarded to our 3rd party processor daily

  • Receives inbound customer service calls and answers claims questions in regards to claim status, verification of eligibility/benefits, and claims payment. Escalates more involved calls to the appropriate level of customer service.

  • Monitors the team's voicemail and distributes calls to the team as necessary.

  • Manually key HCFA and Dental claims ensuring accurate adjudication.

  • Monitors and clears Pended claims as assigned.

  • Manually loads enrollments to Claims system for new companies

  • Researches, drafts, mails and indexes provider letters in response to charges billed to participants

  • Performs other claims clerical functions as needed or requested by the Claims Manager.

Travel Requirements

Travel

Estimated Percent of time Spent

  • Travel between local InnovAge worksites
  • 0%
  • Travel to client and potential client homes and/or other off site locations
  • 0%
  • Overnight travel out of state
  • 0%

Relocation

  • Must be open to relocation based on business necessity

Job Qualifications

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

REQUIRED

Education

  • High School Diploma or GED

Work Experience and Qualifications

  • Ability to type 10,000+ KSPH (alpha/numeric), in addition to being able to produce business correspondence required.

  • 1 year prior claims processing experience

  • Must have six months of basic customer service skills as either a receptionist, inbound customer service representative or other similar position and be able to find and communicate information to callers on an as needed basis.

  • Experience with basic office machines such as copiers, scanners and multi-line phone systems are essential.

PREFERRED

Work Experience and Qualifications

  • Experience with medical billing and/or coding as well as document imaging systems and Medical Terminology is helpful.

  • Medical Terminology is a plus.

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Claims Processor I

Innovage