Claims Technician

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Job Summary

Under Supervision, This Position Is Responsible For Processing Complex Claims Requiring Further Investigation, Including Coordination Of Benefits And Resolving Pended Claims.

Location - Abilene Tx, Office In house position with future possibility of shift flexibility to include hybrid scheduling (1 week in office 2 weeks WFH) based on performance and 12 months of tenure in role. Process complex claims in various queues. Conduct research and investigation into missing information, make phone calls to providers (as necessary), access resource materials and support files in order to process and adjudicate claims timely and accurately. Resolve complex pended claims, duplicate claims, and adjustments. Process claims, involving communications with participating plans and/or Service Units. Resolve various issues. Research and identify other insurance, Medicare, Medicaid, and update patient file as needed. Coordinate benefits; request explanation of benefits as needed. Maintain a working understanding of medical terminology and CPT, HCPCS, and ICD10 coding. Maintain knowledge related to specific contracts. Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS). Periodic overtime may be required at the sole discretion of the employer based on business need.

Required Job Qualifications

High School diploma or GED. Data entry and/or typing experience. Clear and concise written and verbal communication skills. Experience processing medical claims.

Preferred Job Qualifications

Referral preference given to applicants able to take and meet testing criteria. Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding. Knowledge of coordination of benefits principles and terminology. Experience with multi-tasking and prioritizing.

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HCSC Employment Statement

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.