We have partnered with a National 3rd Party Insurance broker who is looking to hire an experience Medical Claims Specialist to oversee a new, high volume account and have 2 direct reports.
Full Revenue Cycle experience is necessary, mainly with Medical Claims!
The company is paying $85K with a flexible schedule of 8:30am-5pm
Summary:
Delivers dedicated and loyal client service and provides oversight of the contractual agreements with specific clients such as state agencies, including departments of public health and insurance departments, program board of directors, and other contractually designated parties. Will perform administrative tasks related to client health premiums and medical out of pocket expenses, interact with clients to provide information in response to inquiries about products and services, handle and resolve complaints.
Duties and Responsibilities include the following.
- Maintains overall knowledge of program, client’s goals and requirements with complete understanding of the program’s operational systems with focus on the system’s ability to produce statistics and information for clients and internal staff.
- Acts as a coordinator to assemble entire reports or responses to clients.
- Establishes strong positive client relationships by maintaining a trusting, open, and professional rapport both with external and internal clients. Serves as a liaison between the client and PAI on many occasions.
- Provides timely response or follow up to questions from both external and internal clients.
- Acts as primary point of contact and communicator with the client during normal business hours.
- Serves as the group facilitator or meeting leader for the assigned program meetings and conference calls.
- Interacts with the customer service team leaders and insurance benefits manager, provides guidance on various issues.
- Conducts quality assurance checks to ensure that SLAs are achieved and that meaningful and accurate reports are being provided to external and internal customers.
- Reviews assigned contract on a monthly basis to ensure obligations are met including: reviewing each deliverable and procedure in the contract, identifying key areas of adherence, maintaining contract compliance, keeping track of renewal dates, and alerting senior management and chief executive office 60 days prior to the contract expiration.
- Strong ability to read EOBs and healthcare terminology.
- Process or adjust medical insurance claims and appeals in accordance with policies and procedures.
- Create an update financial batch records for processing by finance.
- Manage day to day workflow of the team and promote team work and service deliver success.
- Identify research and resolve claim issues. Request for additional documentation.
- Recommend process improvements.
- Other duties may be assigned.
Medical Claims Requirements:
- Medical Coding and Billing Certification or equivalent related experience.
- Medical Claims Processing.
- Previous experience as a supervisor or manager.
- Familiar with medical claims clearinghouse.
Education/Experience:
Bachelor’s degree or 5 years of Account Management experience
. . . Pay Statement and Pay Transparency Laws: rate of pay listed is on a per hour basis. You will be entitled to health insurance once employed for 60 days and you must work 30 hours per week, on average, per month to enroll and maintain health insurance through Complete Staffing Solutions. Once both qualifiers are met you must complete the enrollment packet and your benefits will start on the first of the subsequent month. . . It is our policy to provide equal employment opportunity to all individuals regardless of race, color, sex, sexual orientation, religion, disability, age, veteran status, ancestry, national or ethnic origin or any other legally protected class. We are committed to a diverse workforce. We value all employees’ talents and support an environment that is inclusive and respectful. We are strongly committed to this policy, and believe in the concept and spirit of the law. #ZIP