Senior IT Services Sales Executive

Role description Purpose

Responsible for ensuring the accurate processing and completion of medical claims in accordance with established guidelines and policies. The associate is expected to demonstrate proficiency in applicable product lines within the processing unit.

• Process new claims or modify existing claims as required, adhering to appropriate actions and organizational standards
• Analyze submitted claims to determine whether approval or denial of payment is warranted
• Identify accurate payment criteria to resolve pending claims based on established policies and procedures
• Conduct research on claim edits to determine proper benefit application utilizing set criteria, and apply physician contract pricing for entry-level claims as necessary
• Review and address provider inquiries related to claim adjudication
• Apply knowledge of medical coding (if applicable) and various medical claims forms throughout the claims process
• Demonstrate capability to manage a high volume of repetitive claims efficiently
• Consistently improve productivity to meet or exceed minimum requirements while upholding quality standards

Work Experience

• Must have at least 2 years of experience in medical claims processing
• Familiarity with medical coding, including diagnosis coding and terminology, an advantage

Skillset

• In-depth knowledge of US healthcare practices, medical coding (ICD-10, CPT4, DRG, HCPCS) clinical documentation improvement, medical terminology, EDI, and HIPAA protocols is essential.
• Strong multitasking abilities and capacity to follow documented claim processes independently.
• Excellent verbal and written communication skills suitable for a business environment
• Proficiency in Windows OS and Microsoft Office applications, particularly Excel
• High attention to detail and sound decision-making skills based on available information

Medical terminology, claims management, medical claims processing, clinical documentation improvement, healthcare, ms office, medical coding,