Job TitleResponsibilitiesReview hospital claims and determine action needed to resolve pended claimsProcess and evaluate hospital claims manually or through claims work flowValidate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepanciesFinalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational proceduresReview, finalize and respond to call tracking tickets in a timely manner to provider inquiresPerform additional duties and special projects as assigned by managementQualificationsHigh School Diploma or GED required, some College or Degree preferredMinimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment requiredBasic keyboarding skills requiredStrong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codesDemonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignmentsAble to work well independently and in a team environmentAbility to meet strict deadlines, work well under pressure and in a fast-paced environmentMust meet performance standards including attendance and punctuality