JOB SUMMARY: Provide high quality and efficient analytical and systematic support. Provide necessary information to others within the department to complete claim processes. Analyze and closure of select claims to maximize client savings and revenue.
JOB ROLES AND RESPONSIBILITIES:
1.Obtain additional supporting data from Clients or various systems to complete claim processes.
2.Analyze and administer closure process on select automated claims & back up individuals on other claim closures.
3.Create and execute business correspondence to clients using multiple media formats.
4.Manage complex, escalated, and/or client initiated emails from shared email boxes.
5.Complete post claim closure payment inquiries or status.
6.Adhere to client TAT requirements as relates to response time and required actions.
7.Analyze and process agreement on claims that require manual intervention.
8.Ensure notes, codes and appropriate closure processes for claims are followed and documented in applicable systems.
9.Manage departmental reports and projects as required.
10. Provide backup duties for Vendors, Support Associates, and Receptionist as needed.
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
The incumbent keeps the needs of external and internal customers as a priority when making decisions and taking action. Work is generally complex and requires independent judgment within established guidelines. More complex issues are referred to higher levels. Accurate and timely processing of claim documents and requests directly impacts company revenue and client savings.
Minimum High School Diploma or equivalent (i.e., GED).
Minimum equivalent of 1 year general office experience .
Required licensures, professional certifications, and/or Board certifications as applicable
Knowledge and understanding of healthcare.
Knowledge of HCFA 1500 and UB claim forms
Communication (written, verbal and listening), customer service, mathematical, and organizational skills
Ability to interpret and apply contract/agreement terms.
Ability to process verbal and written instructions.
Ability to multi-task.
Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites, Word, Excel, Outlook, Internet searches.
Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.