As the Claims Processor

　　If you’re ready to explore the next step in your career:

　　You’ll enjoy…

　　Career Opportunities – Tons of growth opportunities for your career

　　Standard Hours – WFH position. Monday-Friday, 8:00 AM - 7:00 PM

　　Competitive Pay - $16.00+ an hour

　　Expedited Interviews – Access to additional Resume support and pre-interview questions

　　Great Benefits – Take advantage of a Blue Cross Blue Shield benefits package (Dental, vision, 401k)

　　Top Local Company – Join one of the largest employers and hospitals within the Hampton Roads area

　　A day in the role…

　　These provider certification claims processors will be responsible for coding a claim (making the corrections necessary) to the correct provider record to clear the edit!

　　The provider certification team is the first set of claim edits that will hit our system.

　　If the claims is 100% correct and everything matches, meaning the provider information is all correct, it will be a clean process and automatically process. If it does process clean, the claim will kick out an edit.

　　All edits that come in for provider are specific to provider information and that is what this team will handle (Examples of provider edits are - address might not match, name may be incorrect, NPI may not be attached.)

　　Usually something wrong with the provider information which is not allowing the claim to process cleanly. There is a lot of research involved. Looking up taxonomy codes, NPI numbers, etc.

　　Process Military and Veterans Health (MVH) claims from receipt through resolution in accordance with MVH regulations, guidelines, and quality standards, with expertise in coordination of benefits (COB), eligibility, and claims development.

　　Analyze claims to determine if eligibility requirements and claim filing requirements are met and make determinations.

　　Calculate Other Health Insurance (OHI) COB amounts using the data from claim such as the EOB or prior payment information given. Identify when to pend to other departments based on guidelines.

　　Translate, research, and verify claim information to determine if all requirements have been met.

　　Review submitted claim information and select correct procedure code and diagnosis code using ICD-10, CPT4, and HCPCS manuals.

　　Adjudicate specialty claims including, but not limited to, pharmacy, ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims or duplicate claims.

　　Need to be comfortable working in a fast paced environment and going back and forth between systems. They may get a claim that comes through that needs them to fully certify a provider who was a NP and now is a DO. They need to do that entire process and then go back to the claim and push it through once the provider is certified.

　　THIS IS A HIGH VOLUME PRODUCTION ENVIRONMENT.

　　Necessary Skills and Strengths:

　　Medical Terminology | EOB | Claims Processing | Insurance Payer Knowledge | Data Entry | NPI Knowledge | Provider Relations | ICD-10 | Modifiers

　　Core Experience:

　　1+ years of health insurance experience

　　1+ years of Medical Claims experience

　　Provider Relations - Insurance Setting

　　Working knowledge of claims processing (verified through references)

　　Claims processing or analyzing experience

　　About TEKsystems:

　　We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

　　The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

　　We are an equal opportunity employers and will consider all applications without regard to race, genetic information, sex, age, color, religion, national origin, veteran status, disability or any other characteristic protected by law. To view the EEO is the law poster click here. Applicants with disabilities that require an accommodation or assistance a position, please call 888-472-3411 or email [email protected]. This is a dedicated line designed exclusively to assist job seekers whose disability prevents them from being able to apply online. Messages left for other purposes will not receive a response.