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Medical Review Clerk

Posting Date:

8-9-2017

Location:

Main Office, Cheyenne, Wyoming

Work Hours:

  • 40 per week, Monday through Friday
  • Daytime only (generally 8:00 a.m. to 5:00 p.m.)

Pay Rate:

  • Hourly rate (Available at time of interview)

GENERAL PURPOSE

Coordinate ordering, processing, and receipt of all medical records to ensure the accurate and timely processing of claims. Monitoring and organization of the claims flow within the Department. Coordinate support services for the department and assist Medical Review employees in all aspects of administrative support.

ESSENTIAL DUTIES/RESPONSIBILITIES

  • Works towards quality initiatives.
  • Requests medical records for applications and claims processing both in writing or by telephone.
  • Answers inquires from other departments in regard to requested information.
  • Answers the telephone when other members are busy.
  • Offers assistance to providers of service, when necessary.
  • Obtains copies of claims and applications requested by other members of the department.
  • Monitors the age report.
  • Department Desk (80/96).
  • Initiates reprocessing of denied claims.
  • Prepare documents for scanning.
  • Must maintain patient confidentiality.
  • Engages in screening activities that do not require clinical evaluation or interpretation, including review of service requests for completeness, collection and transfer of non-clinical data, or acquisition of structured clinical data.
  • Writing letters, updating databases and spreadsheets
  • Has access for consultation to licensed clinicians, while conducting all UM screening activities.

OTHER DUTIES/RESPONSIBILITIES

  • Maintain appropriate forms for incentive programs.
  • Act as a back-up for Care Management Clerk.
  • Other duties as assigned..

SUPERVISORY DUTIES

None.

JOB QUALIFICATIONS

KNOWLEDGE, SKILL & ABILITY:

This position requires a specialized knowledge of the established claims processing flow. 
The ability to extract information from established processing procedure manuals or instructions and apply that information.
Computer literacy and the skill required to accurately transfer claims and process letters and required correspondence.
Proficient telephone skills.
Must have good organizational skills and the ability to multitask. 
This position works under general supervision; work is subject to specific performance and accuracy guidelines or specified production time.

EDUCATION OR FORMAL TRAINING:

High school degree or equivalent

EXPERIENCE:

Two (2) years office experience preferred. Experience in health and/or health related fields or the processing of insurance claims is desired.

MATERIAL AND EQUIPMENT DIRECTLY USED:

Computer and keyboard, computerized health insurance claims processing software, various on-line software, calculator, telephone, fax machine, printer, copy machine.

WORKING ENVIRONMENT/PHYSICAL ACTIVITIES:

Work is in an open office environment. Physical activities include, but are not limited to, keyboard and calculator manipulation, hand carrying claims or other information short distances to various user departments and telephone use.

ACCESS TO PROTECTED HEALTH INFORMATION (PHI)

Access is limited to PHI necessary to carry out tasks related to and essential for job functions listed above.

Note:

Position summary shown may not include ALL of the necessary knowledge, skill, and ability requirements.

Blue Cross Blue Shield of Wyoming
EOE M/F/Vet/Disabled Employer
E-Verify

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