Share this Job

Claims Specialist

Accountable Care Organization

 

Address   Franciscan Health
    5454 Hohman Avenue
    Hammond, IN 46320

Hours  Days/Evenings

Calendar  Full-Time; 40.00/week

Education Associates Preferred

WHAT WE NEED

Persistent, organized financial support

WHO WE ARE LOOKING FOR

Some people love getting to the bottom of things – reviewing medical claims, resolving accounts, digging through the details to identify discrepancies and needs. Yes, we’re talking about people who love claims. And it takes a love of getting into the details to do this job well.

 

Do you have top notch customer service and data entry skills? Are you good at following through on inquiries? Are you accurate and organized? We’d love to talk to you about working here.

WHAT YOU WILL DO

  • Intake, review, processing, and quality control of medical claims.
  • Perform tasks and communication related to claim processing.
  • Assist with issues relating to refunds, subrogation, and coordination of benefits.
  • Answer questions about claims status, provide information required for the appeal process and eligibility information.
  • Process managed care medical claims according to established policies, plan specifications and performance requirements.
  • Assist with appeals, refunds, subrogation, and special projects as requested.
  • Develop and perform quality assurance activities related to claims processing.
  • Provide customer service for plan enrollees, employers and providers by answering questions related to claim status, benefits, payments and appeals when necessary.

WHAT IT TAKES TO SUCCEED

  • Advanced knowledge of automated managed care claims processing and UR software systems, preferably QuickCap 7.
  • Relevant training in claims review and analysis.
  • Experience and knowledge of ICD and CPT coding.
  • Strong Microsoft Office skills.
  • High analytical ability to interpret claims and benefit programs.
  • Strong interpersonal skills.


WHAT WE'RE LOOKING FOR

 

3-5 Years Experience

License(s): Not Applicable

Certification(s): Not Applicable

Travel: Never or Rarely

 

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.


Nearest Major Market: Gary
Nearest Secondary Market: Chicago

Job Segment: Medical, Quality Assurance, Data Entry, Healthcare, Technology, Administrative