Associate BPM Lead (Medical Claims)

RESPONSIBILITIES

• Process new claims or modify existing claims as required, adhering to appropriate actions and organizational standards
• Analyze submitted claims to determine whether approval or denial of payment is warranted
• Identify accurate payment criteria to resolve pending claims based on established policies and procedures
• Conduct research on claim edits to determine proper benefit application utilizing set criteria, and apply physician contract pricing for entry-level claims as necessary
• Review and address provider inquiries related to claim adjudication
• Apply knowledge of medical coding (if applicable) and various medical claims forms throughout the claims process
• Demonstrate capability to manage a high volume of repetitive claims efficiently
• Consistently improve productivity to meet or exceed minimum requirements while upholding quality standards

QUALIFICATIONS

Work Experi...