As part of the Service Operations Team, responsible for accurately entering of AllWays Health Partners correspondence to member and provider records and work within various systems to report and resolve data entry issues and data discrepancies according to department guidelines.
Responsible for reviewing and sorting all incoming correspondence for all departments, including; but not limited to Claims, Grievance/Appeals, COB/TPL, and Member Reimbursement.
Responsible for understanding the distinction between correspondence of business within AllWays Health Partners to ensure proper and effective interpretation of data.
Handle complex and non-complex claim correspondence and strive to response deliver best practice.
Demonstrate strong interpersonal skills, have a high level of initiative, excel in written and verbal communication.
Exceptional awareness of HIPAA regulations to ensure all member PHI is protected while handling high correspondence.
Responsible for reviewing all documentation, logging, forwarding and transmitting correspondence for scanning and/or storage within agreed upon service level agreements.
Analyze and interpret data as it relates to logging of correspondence.
Able to prioritize work tasks with the day to day business from other departments, including Provider Relations, Compliance, Claims, COB/TPL and Provider Appeals.
Oversee the daily assignments of temporary and interns as directed by management.
Responsible for meeting all department quality and productivity performance standards.
Responsible for following all recommended processes and implementing approved process changes effectively to ensure efficiency and productivity levels.
Responsible for identifying and resolving document/imagery discrepancies by utilizing daily reports provided by New England Documents.
Responsible for logging each department's correspondence according to its individual criteria.
Ability to identify trends that may cause a change/increase in correspondence levels, as well as solutions to ensure effective service levels.
Must be able to take initiative in learning, retaining and utilizing all processes, systems and resources.
Meets or exceed daily production goals and quality expectations consistently.
Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
Hold self and others accountable to meet commitments.
Ensure diversity, equity, and inclusion are integrated as a guiding principle.
Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
Build strong relationships and infrastructures that designate AllWays Health Partners as a people-first organization.
Department Specific/Non-Essential Functions:
Must be able to regularly lift up to 20 lbs.
Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort:
Work is normally performed in a typical office work environment. Required:
High School Diploma or the equivalent combination of training and experience, plus 1-2 years of related experience.
Knowledge of Word, Excel and Outlook, Adobe Pro
1-2 years data entry experience.
Excellent written, verbal and communication skills including proficient use of English.
QNXT or similar systems experience
2 years of related experience
Knowledge of enrollment and Insurance claims logging
Knowledge of internal correspondence logging process
Knowledge of claim forms (professional and facility)
Attention to detail, decision making, problem solving, time management and organizational skills, communication and teamwork
Must be able to multi-task and be prepared for quick changes to daily tasks.
Demonstrated competency in high-productivity data entry environment
Good follow-up skills, seeing tasks to completion
Verse in Audit skills with attention to detail.
Demonstrate AllWays Health Partners' core brand principles of always listening, challenging conventions, and providing value.
Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.
Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
Be accountable for delivering high-quality work. Act with a clear sense of ownership.
Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
Certification or Conditions of Employment:
Works with minimal supervision; ensures daily service level agreements are met using available processes and resources.
This position interacts within AllWays Health Partners with team members in various departments, including staff and management level personnel. Outside AllWays Health Partners, this position is responsible for day-to-day interactions with vendor representatives.