Responsible for accurate and timely processing of claims per regulatory and contractual guidelines. Reviews claims involving coordination of benefits, medical coding and authorization allocation. Understanding and application of cost containment techniques with vendor partnerships are utilized to reduce overall cost of claims while applying plan or line of business specific processing rules. Formal Education Required: -High School Diploma or equivalent. Experience & Training Required: -One year ... more details
Claims Processor
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
Remote After Training
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2024 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary:
Responsible for accurate and timely processing of claims per regulatory and contractual guidelines. Reviews claims involving coordination of benefits, medical coding and authorization allocation. Understanding and application of cost containment techniques with vendor partnerships are utilized to reduce overall cost of claims while applying plan or line of business specific processing rules.
Formal Education Required:
-High School Diploma or equivalent
Experience & Training Required:
-One year experience in health insurance claims processing, health claims data entry including Document Management Services (DMS), customer service experience in a managed care environment, physician or hospital billing, and/or patient accounts
Other Skills, Competencies and Qualifications:
-Word and Excel at a basic level. Must achieve passing score on test administered by Human Resources
-MS-windows based computer environment
-Medical terminology, CPT, HCPCs and ICD-10 knowledge
-Familiar with professional (CMS1500) and institutional (UB-04) claim types
-Independent judgment and decision-making skills
-Close attention to detail with independent judgment, decision making and problem solving skills necessary to complete the task being performed
Level of Physical Demands:
-Sit for prolonged periods of time
-Bend, stop and stretch
-Lift up to 20 pounds
-Manual dexterity to operate computer, phone and standard office machines
$17.55/hr - $21.06/hr
The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
