Virginia Premier Health Plan Claims Adjuster II in Glen Allen, Virginia

Overview

The Claims Adjuster II is responsible for the accurate and timely processing of pended claims of moderate complexity received by the Claims Department. The Claims Adjuster II is also responsible for communicating with internal staff, vendors, providers, and billing representatives on the outcome of claims processed as well as the status of outstanding claims.

Responsibilities

  • Process pended claims accurately and within the time frames established by

  • Management and Contractual Agreements using the claims document imaging system and the claims processing system.

  • Manually enter in un-scannable paper claims in the claims processing system

  • Complete ChangeGear tickets assigned within established time frames

  • Master a thorough understanding of such claim types as Nursing Facility, Home Health, and EDCD Waiver services

  • Master a thorough understanding of such items as HCPC and Procedure codes, modifiers and their effect on reimbursement, appropriate billing guidelines for anesthesia claims, dialysis, durable medical equipment (DME), and home health services.

  • Work claims reports as directed by management

  • Work as a unit/team in resolving claims issues or special projects

  • Report any inconsistencies that are identified in regards to internal department policies and procedures or potential billing issues to Management

  • Work with Management to ensure that all existing workloads have been addressed and are within acceptable time frames

  • The ability to provide phone coverage for Claims Customer Service

  • The ability to work overtime as needed

  • Perform other duties as assigned

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • High school diploma or equivalent.

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Experience to IDX and QNXT claims processing systems

  • Strong organizational, written, and verbal skills

  • Exposure to health care environment and knowledge of CMS 1500 and UB04 Claim forms

  • CPT-4 and ICD9/ICD10 knowledge

  • Ability to work independently and in a team environment

  • Ability to meet deadlines and work under pressure in a Production based-Goal oriented environment

WORK BACKGROUND/EXPERIENCE

  • Minimum two (2) years claims processing/healthcare billing experience

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

Our mission is to inspire healthy living within the communities we serve!

Job ID 2018-4600

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.