Claims Processor - Johnstown

Overview

Claims Processor

Full Time – Johnstown, Pa

Senior LIFE is an innovative home and community based Medicare and Medicaid funded program which provides all-inclusive healthcare services and support to seniors living in the community. Senior LIFE makes it possible for seniors to remain at home, enjoying the comfort and reassurance of familiar surroundings while receiving the care they need.  Senior LIFE staff live the mission of the program.  Our team is committed to partnering with our seniors to remain at home through promoting open communication and shared decision making while providing excellent care and services.

To fulfill this mission, Senior LIFE is seeking hardworking, dedicating and compassionate professionals to join its team. Within this team, the Claims Department  is seeking a talented, experienced Claims Processor.

Responsibilities

The responsibilities include:

• Processing of medical claims (Outpatient Hospital, Physician, DME, Pharmacy, Ambulance, etc.)
• Verification of Provider contract language for accurate payment adjudication.
• Weekly claims adjudication/balancing for claims payment.
• Verification of referrals obtained for services
• Preparation of member enrollments for state agency
• Field incoming phone calls regarding claim questions/claim status
• Other billing-based duties, as needed

Qualifications

This position requires a versatile, independent and detail-oriented professional. Prior claims processing experience as well as CPT/HCPCS Coding knowledge is preferred. Working knowledge of Microsoft Outlook, Word and Excel is required.  A combination of in office and remote work  is available for this position.

EOE