Claims Processor

Required Qualifications (as evidenced on attached resume):
Associates degree (foreign equivalent or higher). In lieu of degree, two (2) years of full-time experience in a medical setting may be considered. Four (4) years of full-time experience working in a medical and/or office setting. Previous medical claims processing experience.

Preferred Qualifications:
Medical coding certification. Knowledge of medical terminology, ICD-10 and CPT coding. Experience with Electronic Medical Records (EMR). Experience with an electronic billing system(s). Experience with the Patient Keeper billing system. Knowledge of IDX (scheduling system). Familiarity with World Trade Center Health Program (WTCHP). Familiarity with HIPAA. Proficiency with Word and Excel.

Brief Description of Duties:
The successful candidate must possess excellent organizational and communication skills. S/he should have a strong sense of responsibility and initiative, use sound judgment in making decisions, and have the ability to work independently under minimal supervision. S/he will be responsible for assisting the Claims Manager with the following duties:

• Verifying accuracy, completeness and compliance with WTCHP guidelines. Validating and releasing both internal and external claims.
• Research claims for payment in the WTCHP InterChart and EMR. Confirmed the patient was WTC-referred and services were authorized.
• Confirm receipt of office notes and/or test results, and other criteria as determined by the program such as certifications, correct coding, operative reports, etc.
• Facilitate resolution of claims received that are not complete and/or do not comply with the Program guidelines. Deny claims when appropriate.
• Assist in the resolution of billing issues, i.e., WTCHP program billed in error, program billed as secondary insurance, out of network providers billed in error.
• Ensure that vendors and providers are in the WTCHP network, when necessary.
• Work with Claims Manager to have vendors and/or providers added to the network.
• Assist in the education of program guidelines and claims processes to external providers.
• Assist in the maintenance of the comprehensive claims process, i.e. through input of suggestions for quality improvement or revisions to best practices. \
• Other duties as assigned.

Special notes:
The Research Foundation of SUNY is a private educational corporation. Employment is subject to the Research Foundation policies and procedures, sponsor guidelines and the availability of funding. FLSA Non-Exempt position, eligible for the overtime provisions of the FLSA.

**The incumbent must be willing to work and travel between the Nassau and Commack clinic locations. Occasional Evenings and Saturdays will be required.

For this position, we are unable to sponsor candidates for work visas.

Resume/CV and cover letter should be included with the online application.

Stony Brook University is committed to excellence in diversity and the creation of an inclusive learning, and working environment. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, pregnancy, familial status, sexual orientation, gender identity or expression, age, disability, genetic information, veteran status and all other protected classes under federal or state laws.

If you need a disability-related accommodation, please call the university Office of Equity and Access (OEA) at (631) 632-6280 or visit OEA.

In accordance with the Title II Crime Awareness and Security Act a copy of our crime statistics can be viewed here.

Visit our WHY WORK HERE page to learn about the total rewards we offer.

SUNY Research Foundation: A Great Place to Work.

The starting salary range (or hiring range) to be offered for this position is noted below, it represents SBU's good faith and reasonable estimate of the range of possible compensation at the time of posting.