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Document processor Jobs in Honolulu, HI
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Claim Processor II
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Job Description
Job Description
JOIN UHA’S TEAM
We focus on your health and pay 100% for your family's medical insurance and provide 20 days of paid personal time off during your first year!
Claim Processor II
Department : Claim Services
FLSA Status : Full time, Non-Exempt
Salary Level : 3
Position Summary :
Process and adjudicate for payment all assigned EDI (electronic data interchange) and / or Paper claims, which includes but are not limited to medical and vision claims submitted by rendering providers, facility inpatient, and outpatient hospital to meet the department’s established performance standards, State of Hawaii Revised Statutes’ claims turnaround and department’s payment accuracy.
Essential Duties & Responsibilities :
- Help Claims Processor I review, and complete OCR validation of scanned claims as needed.
- Review and process different types of electronic or paper medical claim forms (CMS 1500 / UB-04)
- Analyzing and calculating coordination of benefit payments
- Create claims processing system memo to identify, track, and pay or deny claims in accordance with the Third-Party Liability policy and medical benefits guide.
- Review and process CMS 1500 Out of State claims in accordance with UHA’s out of state network policy and requirement criteria from start to finish.
- Re-pricing out of state CMS 1500 and UB04 claims, and process through QNXT using Out of state network.
- Assist in updating and maintaining Claims Processing Policy and Procedure Manual
- Help with basic training for Claims Processors when necessary.
- Consistently maintain regular and reliable attendance
- Perform other duties as assigned and asking for additional duties when workload permits.
Required Education and Experience :
The individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Preferred and Advanced Qualifications :
Physical Demands / Working Conditions :
The work environment characteristics described here are representative of those associate encounters while performing the essential functions of this job.
See Associate Handbook – Employment Policies – Position Descriptions for general work environment.
This position is eligible to work from home subject to management’s approval
Competitive compensation & excellent benefits offered
Visit our website at https : / / uhahealth.com / page / career -opportunities to apply and for details about vacant positions.
An Equal Opportunity Employer