Document Processor Overnight Jobs in Georgia (NOW HIRING)

MISSION Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.VALUES HealthOne is guided by a cultural framework that embodies our values and drives our decisions. As a company our PURPOSE is to care for people by connecting them to resources that help protect them in health related situations. We fulfill our purpose by filtering our decisions through a PRIORITIES lens of asking, "Is what we are about to do ethical, empathetic, economical, and efficient?". By caring for PEOPLE, we are welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our PROCESS and how we get things done.HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.JOB PURPOSEThe Claims Processor II is responsible for accurate and timely processing of both professional and institutional medical claims pended for manual adjudication in assigned Workflow roles. The Claims Processor II will accurately interpret benefit and policy provisions applicable to fully-insured plan members and review claims to determine coverage based on contract, provider status, and claims processing guidelines. The incumbent must meet quality and productivity standards.ESSENTIAL JOB DUTIESReviews and adjudicates claims up to specified dollar limitsProcesses claims within performance guidelines of the department, including quality and timelinessWorks with and understands Company benefit plansUnderstands provider contractsExamines and interprets all relevant documents included with the claimsResponds to claim-specific questions, as applicablePartners with leadership on any questionable claim activityUnderstands logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.)Determines accurate payment criteria for clearing pended claims based on defined Policy and ProceduresResearches claim edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for claimsWorks high volume of repetitive claimsIdentifies claims with inaccurate data or claims that require review by appropriate team membersContributes positively as a team playerCompletes special projects as assigned and supports other Claims Department team members in assigned projectsComplies with all departmental and Company policies and proceduresMaintains regular and predictable attendanceConsistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practiceWorks to encourage and promote Company culture throughout the organizationOther duties as may be assignedQUALIFICATIONSHigh School Diploma or GED requiredAssociates or Bachelor's Degree preferredA minimum of one year experience in claims processing required, must include Professional and Institutional processing; previous experience in medical billing and coding required if no claims processing experienceKnowledge of ICD-10, CPT4, DRG, HCPCS codes, medical terminology, EDI and HIPAA protocols preferredKnowledge of UB and HCFA 1500 formsCertified Professional Coder (CPC) preferredExperience with Word and Excel PHYSICAL REQUIREMENTSProlonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.BENEFITS 401K (4% Match, Immediate Vesting) Accident insuranceCompetitive salaryCritical Illness InsuranceDental InsuranceEmployee Assistance ProgramFlexible Spending AccountHealth & Wellness ProgramHealth Savings AccountLife & AD&D InsuranceLong Term DisabilityMedical InsurancePaid Time OffPet InsuranceShort Term DisabilityVision Insurance PRE-EMPLOYMENT SCREENINGDrug Screen and Background Check RequiredHEALTHONE IS AN EQUAL OPPORTUNITY EMPLOYERAll qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status or any other status protected by state or federal law.