University Hospitals Claims Processor - Remote in Pittsburgh, Pennsylvania

Claims Processor - Remote

University Hospitals

Pittsburgh, Pennsylvania United States

As a Third Party Administrator (TPA) Health Design Plus (HDP) offers customized approaches to help organizations provide high-quality, cost-effective health care to employees. Our core business includes care management, network development and management, claims payment, customer service and benefit support services.

At HDP, we are committed to delivering innovative, member-centered solutions for our clients. We partner with employers to design and administer healthcare programs that achieve their goals. Our ability to implement creative new programs and new approaches to population health management has led to successful and sustained relationships with our TPA clients and interest in the wider market place for our non-core programs.

Our recent affiliation with University Hospitals of Cleveland, OH (UH) allows us to optimize our organizational strengths and enhance our offerings.

At HDP , we value capable and motivated individuals who strive for excellence. If you value a casual dress environment, enjoy a challenge and a fast-paced work setting, we invite you to apply today so you can be part of the HDP team.

Minimum of two weeks training in Hudson. After fully trained, this position will be remote.

Job Summary

  • To ensure that all claims received for medical, dental and vision services are paid accurately and promptly in accordance with policies and procedures, client specific summary plan descriptions and performance parameters set forth in the client’s contract.

Key Responsibilities

  • Meet the HDP productivity and quality standards that relate to the processing of claims

  • Ability to consistently meet Production (22-25 claims per hour) and quality standards

  • Ability to read explanation of benefits and apply coordination of benefits

  • To ensure all the performance requirements are met for the client

  • Ability to understand and process multiple different client benefit plans

  • To identify issues in the system or claim flow impacting the quality and/or productivity of the department and report them to the supervisor/manager

Job Requirements (Education/Certification/Skills/Competencies/Experience)

  • 2 year medical claims processing experience preferred

  • Knowledge of health benefit plans and health benefit terminology

  • Knowledge of medical terminology

  • Understand CPT, IDC9 and HCPCS coding

  • Experience with dental and vision claims preferred, but not necessary

  • Ability to utilize a claims processing system

  • Ability to read an Explanation of Benefit and apply Coordination of Benefits

  • Proficiencyin Microsoft Excel and Word

  • Good communication skills, both written and oral

  • Good organization skills