Job description
Partner with management in the design, implementation and maintenance of claims processing programs and procedures. Verify that claims are being adjudicated or submitted according to Magellan contracts in a consistent and accurate manner. Manage projects and administrative duties as required by business need. Lead and implement positive changes with a high level of quality and professionalism.
Excellent command of ICD-9 codes and Current Procedural Terminology (CPT)
Excellent decision making, analytical, organizational, presentation, communication (verbal and written), coaching and leadership skills.
- Adjudicate or submit claims and adjustments as required.
- Track and trend performance of root cause analysis and provide additional training as needed.
- Resolve claims edits and suspended claims.
- Maintain and update required reference materials to adjudicate or submit claims.
- Continuously identify process improvements that impact quality and service results; recommend solutions.
- Provide backup support to other team/group members in the performance of job duties as assigned.
- Serve as a resource (buddy) for newly hired associates and/or assist with remedial training for existing associates as needed. Prepare feedback and review for Supervisors and Managers.
- Handle all types of requests, inquiries and complaints accurately and timely, to include written correspondence and phone inquiries from internal customers.
- Assist with the maintenance and updating of the business unit?s reference materials.
Other Job Requirements
Responsibilities
Ability to quickly use a 10-key machine
Excellent command of ICD-9 codes and Current Procedural Terminology (CPT)
Excellent decision making, analytical, organizational, presentation, communication (verbal and written), coaching and leadership skills.
General Job Information
Title
Lead Claims Processor
Grade
21
Work Experience - Required
Claims
Work Experience - Preferred
Education - Required
Education - Preferred
Bachelors
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$45,655
Salary Maximum:
$68,485
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
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