Process Executive
2 months ago
**Job Summary**
**Responsibilities**
- Process healthcare claims accurately and efficiently to ensure timely adjudication.
- Review and analyze claims data to identify discrepancies and ensure compliance with industry standards.
- Collaborate with team members to resolve complex claims issues and provide support as needed.
- Maintain up-to-date knowledge of healthcare regulations and payer policies to ensure accurate claims processing.
- Utilize claims adjudication software to input and manage claims data effectively.
- Communicate with healthcare providers and payers to obtain necessary information for claims processing.
- Monitor and track claims status to ensure timely resolution and payment.
- Provide excellent customer service by addressing inquiries and resolving issues related to claims.
- Participate in training sessions to stay current with industry changes and updates.
- Assist in the development and implementation of process improvements to enhance claims adjudication efficiency.
- Generate reports and analyze claims data to identify trends and areas for improvement.
- Ensure confidentiality and security of patient information in compliance with HIPAA regulations.
- Support the team in achieving departmental goals and objectives through effective claims management.
**Qualifications**
- Possess a strong understanding of claims adjudication processes and procedures.
- Demonstrate excellent analytical and problem-solving skills.
- Exhibit strong attention to detail and accuracy in claims processing.
- Have good communication skills to interact with healthcare providers and payers.
- Show proficiency in using claims adjudication software and other relevant tools.
- Display the ability to work collaboratively in a team environment.
- Maintain knowledge of healthcare regulations and payer policies.
- Have a basic understanding of commercial claims claims and payer domains.
- Demonstrate the ability to manage multiple tasks and prioritize effectively.
**Certifications Required**
Certified Professional Coder (CPC) or equivalent certification in claims adjudication.
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