Claims Processor WORK FROM HOME! (Must live in the Denver area) Job Vacancy in Delta Dental of Colorado Centennial, CO 80111 – Latest Jobs in Centennial, CO 80111

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Company Name : Delta Dental of Colorado
Location : Centennial, CO 80111
Position : Claims Processor WORK FROM HOME! (Must live in the Denver area)

Job Description : If you are located in the Denver metro area, you can be a Claims Processor and work from home!Essential Duties:

Reviews Daily Inventory to determine workflow to maintain department turnaround time expectations.
Receives and works queue inventory through the processing system.
Researches claims / pre-treatment estimates for supporting documentation including eligibility, applicable benefits, processing policies and coordination of benefits.
Processes and resolves system-generated editing and error coding.
Researches, resolves and processes daily workflow via mailbox routing system.
Initiates manual requests for required supporting documentation.
Provides daily assistance to mail center for efficient workflow process of all incoming correspondence.
Researches, resolves and processes appeals, checks and paper workflow in folders to maintain the inventory levels according to department goals.
Completes manually pricing according to guidelines and contract agreements.
Identify procedures requiring review and refer to appropriate consultant with all required documentation. Maintain tracking, decision and claim resolution of the referral within the system.
Analyzes, researches, adjudicates and documents required manual claim adjustments determined by analysis of system claim and benefit data.
Customer service duties to include responding and initiating calls to providers, subscribers and group administrators to resolve claims issues.
Accurate documentation and tracking for all communications within the system.
Working knowledge of benefit coverage, processing policies, products and provider networks provided by DDCO.
Responsible for maintaining and ensuring all procedures in the operations department are in compliance with HIPAA standards and regulations.

Additional Duties:

Performs other duties as assigned.

Competencies:

PC experience using keyboard functions and 10 keys by touch.
Ease in using Windows, Word, Excel, Outlook and Zoom required.
Effective written and verbal communications skills. Ability to effectively communicate and interact with all levels of personnel and the general public.
Ability to work independently and multitask.

Qualifications:

High school graduation or equivalent.
2 years of previous claims processing, including preparation of payment of medical / dental involving application of contract terms using medical / dental terminology, applicable coding / procedure codes CDT/CPT.
Dental assistant experience is a plus.

Equipment Utilized:

General office equipment experience (i.e. personal computer windows-based environment).
*Scope of Authority:
Responsible for accurate and timely adjudication of claims in accordance with applicable claims processing guidelines.
Financial Authority:
No independent financial authority or responsibilities.

Work Conditions:

Moderate physical effort is generally required handling objects up to 20 pounds occasionally.
Work may require sitting for extended periods of time.
Regular and reliable Attendance is required.
The noise level in the work environment is usually minimal. Primarily sedentary work with regular exposure to a computer screen.

Delta Dental of Colorado offers a comprehensive compensation and benefits package which includes generous PTO and 9 paid holidays; two affordable health plans; free dental insurance; 401(k) match with immediate vesting; supplemental retirement savings plan; company-paid life insurance, short-term disability and long-term disability policies; wellness program; tuition reimbursement; transportation reimbursement (we’re near a light rail station); annual bonus program; paid volunteer time off and much more.The Claims Processor position pays $20.00 per hour.Delta Dental of Colorado is proud to be an Equal Opportunity and Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, genetic information, military or veteran status, national origin, race, religion, sex, sexual orientation or any other applicable status protected by state or local law.
ExperienceRequired

2 year(s): 2 years of claims processing experience, including the preparation of payment of medical/dental claims involving application of contract terms using medical/dental terminology, applicable coding/procedure codes CDT/CPT.

Preferred

Dental assistant experience a plus.

EducationPreferred

High School or better

SkillsRequired

Microsoft Outlook
Microsoft Word
Microsoft Excel

Preferred

Dental Assistant

Job Type: Full-time
Pay: $20.00 per hour

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