Process Medicaid professional claims in a workflow role environment. Accurately interpret benefit and payment provisions applicable to Medicaid enrollees. Review and resolve claim edits using multiple systems, processes and procedures. Maintain production and quality standards.
Work Experience: One year of experience working for PacificSource, or one year of claims processing experience.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Basic-intermediate proficiency in Microsoft Office Applications including Word and Excel. Basic knowledge of medical terminology and medical coding preferred. Knowledge of claims, authorization, and provider network preferred. Basic knowledge of Government Programs (Medicare/Medicaid) structure preferred. Excellent time management, critical thinking and research skills preferred.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.