Claims Service Analyst Ii
Hampton, Virginia, United States
Analyze Tricare health insurance claims to determine if eligibility requirements and claim filing requirements are met and make determinations.Calculated Other Health Insurance (OHI) COB amounts using the data from claim such as the EOB or prior payment information given. Identify when to pend to other departments based on guidelines.Processed all claim types by determining corrective action to be taken on various types of errors pended by the system and resolving interactive edits.Interpreted, researched, and verified claim information to determine if all requirements have been met.Review submitted claim information and select correct procedure code and diagnosis code using ICD-9, ICD-10, CPT4, and HCPCS manuals.Deal tactfully with people in a wide variety of situations to convey a favorable corporate image.Adjudicate specialty claims including, but not limited to, pharmacy, ambulatory surgery, skilled nursing, dental, anesthesia, medical assistance, reprocessed claims, duplicate claims, ambulance, durable medical equipment (DME), or institutional based charges.Contact providers and beneficiaries for missing claim information to process the claim through.