Job Description
Job Description
PRINCIPLE CHOICE SOLUTIONS
VA Claims Processor
POSITION PURPOSE
This position will complete distribution or processing (review and determine payment of claims) for FMP, Spina Bifada, CHAMPVA, Beneficiary Travel and Non-VA Medical Care claims for the VA. This includes processing claims from the Aged Claims inventory and any current claims as requested by the VA CBO and will utilize the VA systems for claims adjudication. Training will be provided on all VA claims systems.
ORGANIZATION
This position reports to the designated Operations Manager for Principle Choice Solutions.
ESSENTIAL FUNCTIONS
- Research and evaluate accounts for proper adjudication.
- Perform electronic claims editing and submit claims validation for payment processing.
- The systems used, include but are not limited to, the ClaimsXM system, Datanet, and the Daper system.
- Utilize VA's contracts to evaluate accuracy of payment.
- Document claims processing activity into VA systems.
- Maintain a working knowledge of applicable VA regulations as they relate to proper claims adjudication.
- Maintain access for all client systems, as assigned.
- Meet/Exceed monthly productivity and accuracy standards.
- Acts as an effective team member.
- Other duties as assigned.
KNOWLEDGE & EXPERIENCE
- High School Diploma or GED required.
- Candidates must provide two valid forms of identification, one of which must be either a REAL ID (indicated by a star in the top corner) or a valid U.S. passport.
- Preferred 1-2 years' experience in medical claims, patient accounting, comprehension of insurance contracts and/or EOBs, and other medical billing methodologies or demonstrated ability.
- Demonstrated negotiation skills.
- General office skills and knowledge of standard office equipment.
- Working knowledge of software such as Excel and Word.
- Data entry and 10 key experience necessary.
- Excellent verbal and written communication skills
- Personal traits of a high-level commitment, motivation, energy, team orientation, professionalism, trust, personal honesty and integrity, and a demonstration of placing others in a place of high value.
GENERAL AREAS OF ACCOUNTABILITY:
Must conduct business and personal affairs in a manner that is always a credit to the company. Must maintain a good credit rating while employed with the company.
May be required to apply for and maintain NACi or higher-level security clearance to support government (DoD, VA, etc.) assignments.
MACHINES & EQUIPMENT
The incumbent must be able to effectively operate the current computer system, telephone system, and other office machines such as a copier.
PHYSICAL REQUIREMENTS
Must be able to lift and carry up to 20 pounds. Must be able to talk, listen, and speak clearly on the telephone.
WORKING CONDITIONS
The incumbent works in a remote environment that is not substantially exposed to adverse environmental conditions such as heat, cold, or extreme noise. Routine periods of being on the phone utilizing a headset, sitting and data keying are required. Periodic times working at the office site may be required.
Security and privacy training will be provided as part of this role to protect the confidentiality, integrity, and availability of PCS’ associate and customer data.
The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
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