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| Job Number: | 26969957 | | Company Name: | BlueCross BlueShield of Louisiana | | Job Location: | Baton Rouge, LA US | | Job Category: | Insurance |
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Adjustment Processor
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Adjustment Processor
Location: Baton Rouge, LA
Company Order Number: 10-419, 10-420
# of openings: 2
Description
QUALIFICATIONS:
Must have a High School Diploma, or equivalent.
A minimum of six months of experience in the healthcare industry to include six weeks processing Blue Cross claims.
Strong analytical ability, oral and written communication skills and human relations skills are necessary.
Working knowledge of relevant PC software.
ACCOUNTABILITIES:
Daily review, research, and make necessary adjustments received through AR, memo, recons, audit, Financial Investigations, MSP, or changes in coverage on local contracts (following departmental and corporate guidelines) to include recalculation of benefits to previously processed hospital, professional, major medical, Medicare, Dental, AIE, CIE, and PIE claims submitted with incorrect codes or were processed incorrectly in the claims area for traditional contracts, PPO contracts, HMO/POS contracts, CSD contracts, FEP contracts, and dental contracts so that the subscriber and/or provider claim is processed according to contractual benefits ultimately providing a high degree of customer satisfaction.
Review F01 and NMIS for correction or routing within 24 hours of receipt following departmental and corporate guidelines to ensure accuracy of claims processing ensuring customer satisfaction.
Manually process claims on a daily basis that have previously gone through claim check (HST) to ensureaccuracy of claims processing and customer satisfaction.
Initiate procedures to recover funds from providers, subscribers, or beneficiaries where overpayments haveoccurred to ensure accuracy of claims processing and financial stability.
Initiate oral and written communications with all internal departments as well as required external parties daily to complete adjustment process and ensure a high degree of customer satisfaction.
Maintains and records information necessary for the Work Management Module, number of adjustments processed and hours worked, on a daily basis, in order to retain historical data needed to continually refine and define to special claims processor position as needed to ensure high customer satisfaction.
This position reports to a Supervisor in Benefits Administration.
This position is a grade level 6. The minimum starting hourly rate is $12.32/hrly.
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