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Job SummaryThis position is responsible for pricing Live Production Claims in a timely manner that are routed into Pricing Claim Queues from The Claim Processing System. These include all claim Types, EG Inpatient, Outpatient, and Professional and are also for all product lines to Include Fep, Bluelincs Hmo, Aso, Local, And Bluecard. This role will also manage Specialty or Contested Claims to ensure the accuracy of fee schedules and pricing. Additionally Identifying pricing issues and appropriately presenting to management for resolution. Updating various databases used by the department to manage reporting issues and collaborating with claims area on misrouted training opportunities. Additional duties as assigned including, but not limited to audit cross training and back-up.JOB REQUIREMENTS:
* Associate's degree in a health related field, business, computer science or social sciences, or substitute two years of experience in health claims processing for each year of college not completed.
* 4 years' experience in health insurance claims, claims systems.
* Knowledge of and experience in the use of HCPCS/CPT4, ADA
* ASA coding structures and customer service.
* Knowledge of AMA, BCBSA and HCFA coding guidelines.
* Internal plan claims coding guidelines and policies.
* Knowledge of mainframe computer access, applications, and tools.
* Experience using MS Office and mathematical skills
PREFERRED JOB REQUIREMENTS:
* Knowledge of fee schedules, reimbursement mechanisms and rates.
* Knowledge of Provider Contracts and Microsoft Excel.
* PREMIER Pricing system and Pricing Strategies.
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HCSC Employment Statement:HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.