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Claims Processing Specialist

Perspecta – Hingham, MA

Every day at Perspecta, we enable hundreds of thousands of people to take on our nation s most important work. We re a company founded on a diverse set of capabilities and skills, bound together by a single promise: we never stop solving our nation s most complex challenges. Our team of engineers, analysts, developers, investigators, integrators and architects work tirelessly to create innovative solutions. We continually push ourselvesto respond, to adapt, to go further. To look ahead to the changing landscape and develop new and innovative ways to serve our customers.

Perspecta works with U.S. government customers in defense, intelligence, civilian, health care, and state and local markets. Our high-caliber employees are rewarded in many waysnot only through competitive salaries and benefits packages, but the opportunity to create a meaningful impact in jobs and on projects that matter.

Perspecta s talented and robust workforce14,000 strongstands ready to welcome you to the team. Let s make an impact together.

Perspecta has an immediate need for a Provider Enrollment Specialist in Hingham, MA.

Position Overview:

NHIC processes Medicare claims and Provider enrollment applications. This position is for a Claims Processing Specialist to perform clerical tasks involved in an organization. This position will support all facets of the Claims Processing team. The person selected for this position must have strong healthcare claims processing experience. The position mandates prior claims processing experience, good communication skills as well as strong time management skills and the ability to multi-task. Responsibilities:
  • Adjudicate Medicare claims and take appropriate actions to resolve discrepancies.
  • Researches and processes claims according to business regulation, internal standards and processing guidelines.
  • Verifies the coding of procedure and diagnosis codes.
  • Coordinates with internal/external departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.
  • Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
  • Determines whether to return, deny or pay claims following organizational policies and procedures.
  • Performs research on claim problems by utilizing approved policies, procedures, reference-training materials, forms and coordinates with various internal support areas.
  • Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
  • Ensures claims are processed according to established quality and production standards.
  • Assists the Claims lead processor in training or mentoring new staff members.
  • Responds to routine correspondence and provides customer service support for on-line and phone call inquires and/or complaints.
Education and Experience Required:
Must be a US Citizen or Green Card Holder who has lived in the US 3 out of the past 5 years.
  • High school diploma or equivalent; may hold post-high school degree
  • 1 years of experience in an office setting environment using a computer as the primary instrument to perform job duties
Knowledge and Skills:
  • Ability to operate PC based software programs or automated systems preferred
  • Strong communication, analytical, and problem solving skills
  • Knowledge of medical terminology; standard claim forms and physician billing coding; standard reference materials
  • CPT, ICD-9/IDC10; coordination of benefits
  • Ability to self-manage in a fast-paced, detail-oriented environment
  • Excellent data entry skills are required
  • Ability to work in an environment that requires repetitive motion such as keying, copying and scanning
  • Ability to sit for extended periods of time

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