Unix Database Administrator

Keystone Mercy Health Plan, Pennsylvania?s oldest, largest, and fastest growing Medicaid HMO serves more than 240,000 members.  Headquartered just outside of Philadelphia near the International Airport, our corporate parent partners are Mercy Health System and Keystone Health Plan East, the managed care division of Independence Blue Cross. 

 

We are currently seeking an exceptional and dynamic CLAIMS EXAMINER I to join our team of talented professionals in our Philadelphia, PA location. 

 

Under the leadership of the Claims Supervisor, the Claims Examiner is responsible for the timely and accurate adjudication of medical and hospital claims.


The ideal candidate is required to have excellent knowledge of claims processing rules. Maintain production standards as established by management to meet ?time to pay? requirements.  Maintain quality standards of at least 96.5% financial and 98.4% procedural accuracy by utilizing all Healthcare screens to insure proper payment.  Independently works suspended claims on a daily basis.  Uphold confidentiality of claims.  Perform other related projects and duties as assigned.  Adhere to KMHP policies and procedures.  Consistently uses on-line references.  Bring claim processing issues to the attention of the supervisor and/or team leader.  Demonstrate a willingness to be cross-trained.  Provide excellent attention to detail. Understand and apply coordination of benefits guidelines as needed.  Perform other duties as requested by supervisor or manager.  Supports and carries out the Mercy Mission and Values.


Qualifications:

High School Diploma or equivalency required.

1 year of claims processing /medical billing and/or claims training certification.

Knowledge of medical terminology, CPT and ICD 9 codes.

Ability to resolve complex issues quickly, accurately while demonstrating leadership capabilities.

Ability to assess various situations, recommend process improvement initiatives and proceed with an implementation strategy.

Basic computer skills with a proficiency of Microsoft Office products.

Good oral and written communication skills.

Ability to type 55 wpm.

Good organizational skills.

 

All submissions should reference CE1MON.  Interested candidates should forward their resume, salary expectations and (3) professional references to MDrecruit@kmhp.com .

 





Keystone Mercy Health Plan offers a competitive benefits package; salary that includes no city wage tax for non Pennsylvania residents, free parking and an exceptional work environment for an energetic individual who will join a team of competent and compassionate individuals to carry out our mission.  We pride ourselves on the opportunities available to our associates to learn, grow and advance their careers. 

 

Agency assistance not needed at this time.