Description

Resolves pended claims while meeting or exceeding the designated production and quality standards. Updates data and configuration within the MC400 system.

Responsibilities:

• Working knowledge of McNet/Batch errors
• Mentor new team members
• Interact with internal and external customers to resolve claim adjudication/adjustment issues
• Maintain mail date integrity
• Maintain employee/insured confidentiality
• Resolve outstanding items in accordance with designated standards
• Successfully complete special projects within designated standards
• Must be able to manage multiple priorities according to designated standards
• Openly participate in team meetings and offer ideas and suggestions to ensure client satisfaction and promote teamwork
• Worked department overtime as required per business need
• Process standard to complex adjustments (project reports, claim adjustment pends, corrected claims, CUT logs) according to designated standards, while meeting or exceeding production and quality goals
• Assist with department or other department backlogs as needed
• Assist with entry/adjudication of claim testing
• Process standard to complex claims in accordance with company policy and procedures in a timely manner while meeting or exceeding production and quality goals
• Participate in training programs

Qualifications

• High school diploma or equivalent.
• Two years claims processing experience required.
• Ability to use a QWERTY keyboard.
• Knowledge of medical terminology, ICD-9 and CPT coding required.
• Knowledge of commercial, Medicaid, and Medicare products preferred.Competency in MS Office and PC skills preferred.
• Ability to demonstrate organizational, interpersonal, and communication skills.
• Ability to prioritize and perform multiple tasks while maintaining designated production and quality standards.
  
  Licensure, Certifications, and Clearances:
  
  UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.