Claims Examiner III, El Paso Health in El Paso, Texas at University Medical Center of El Paso

Job Summary
Responsible for adjudicating Institutional (UB04) and Professional (CMS1500) claims. Calculates benefits for manually processed claims, attachment claims, complaint/appeals, and special project claims. Meets production and quality standards.

Skills
1. Knowledge of medical terminology preferred.
2. Knowledge of 10 key calculator.
3. Able to work in fast-paced office with heavy telephone calls, talking, and frequent interruptions.
4. Ablility to interact professionally with other departments and providers in resolving claims issues.

Work Experience
Two years of work experience required, which includes the processing of professional (CMS1500) and institutional (UB04) claim types. Knowledge of contract renewal, calculation of benefits for manually processed claims, attachment claims, complaint/appeals, and special project claims. Understanding CPT-4, HCPCS, and ICD-9 diagnostic coding, and familiarity with the State of Texas local coding guidelines and Corrective Coding guidelines.

License/Registration/Certification
Completion of a formal CPT Coding Certification and Insurance Processor program preferred.

Education and Training
High school graduate or equivalent. Associate degree preferred.