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About the role
Key responsibilities & impact- Process claims edits accurately
- Determine primacy for Coordination of Benefits (COB)
- Adjust previously paid claims
- Initiate procedures to recover funds from overpaid claims
- Review, research, and update claims, including recalculation of benefits, claims edits, and refund requests
- Apply contractual benefits and provider reimbursement rules
- Identify denial codes, edits, and processing codes to process coordinated and non-coordinated claims correctly
- Request medical records when required
- Communicate with internal and external contacts to maintain accurate claim records
- Review quality audits and correct or route them within 48 hours
- Research and determine the correct order of benefits and make COB record corrections
- Communicate Medicare primacy discrepancies to the appropriate department and ensure notification letters are generated
- Assist with training, implementations, documentation, and other assigned duties
- Report to the Supervisor, Claims Operations
- Collaborate with internal departments, providers, members, lawyers, groups, insurers, and other plans
Requirements
What you’ll need- High School Diploma or equivalent required
- 6 months of experience in medical claims or health insurance-related customer service, or successful completion of BCBSLA adjustment or COB training
- Certification in Medical Billing or Coding can be used in lieu of experience
- Strong analytical ability
- Oral and written communication skills
- Human relations skills
- Working knowledge of relevant PC software
- Must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support
- Must not require current or future employment-based immigration sponsorship or employer support
- Must complete pre-employment drug screening with satisfactory results
- Felony convictions involving dishonesty or breach of trust require written consent from the state insurance commissioner to work in the insurance industry
Benefits
Comp & perks- Resources to live well and be healthy
- Learning and professional development opportunities
- Skills development and professional growth
- Opportunities to serve local communities
- Reasonable accommodations for individuals with disabilities
- Smoke- and tobacco-free workplace
- Background and pre-employment drug screening
- Drug-free workplace