Job Description:
ROLE REQUIREMENTS:
1. At least one year of office experience with an emphasis on data entry into various mainframe and client server environments, some experience in the PPO industry.
2. Minimum of 40 wpm typing.
3. Ability to analyze information on all forms of incoming correspondence to determine required information to be entered into the computer system.
4. Proficiency with a ten-key calculator and keypad on a computer.
5. Ability to perform basic math skills.
6. Ability to read, comprehend and follow written or verbal English instruction.
7. Good telephone skills with the ability to express self clearly and respond accurately and professionally.
8. Medical terminology and CPT coding desired.
9. Strong organizational skills.
10. Experience with alpha sorting and filing and mail support functions.
11. Ability to operate a photocopier.
12. Ability to operate a fax machine.
13. Ability to sit and stand for long periods of time for up to 7.5 hours per day.
14. Ability to meet company attendance requirements.
15. Ability to achieve and maintain department quality and production standards.
16. Ability to walk and carry up to and more than 15 pounds for short periods.
17. High school diploma or equivalent.
ROLE RESPONSIBILITIES:
1. Enter data obtained from all types of mail - hard copy claim forms, electronic claims, billings and correspondence into the appropriate computer system, according to departmental needs and requirements by:
a. Identifying and selecting the correct insured and claimant by searching computer files utilizing multiple systems or platforms as needed.
b. Resolving exception messages that prohibit the charge transferring to production.
c. Determining appropriate entry action based on the information provided on each charge or billing summary.
d. Determining appropriate action on claims correspondences by visually reviewing each piece to be worked.
e. Making necessary phone calls to obtain incomplete or invalid information from the charges, documenting the calls.
f. Reviewing correspondence to determine if requested information has been received.
g. Making any necessary modifications or corrections to insureds claim file manually or through EDI.
2. Search and maintain provider information obtained from manual entry of claims forms or from EDI transmissions of claims in the applicable computer system according to departmental needs and requirements:
a. Maintaining the provider database with updates received via correspondence, W9s, charges and telephone calls.
b. Performing query/search to verify provider information for each manually entered claim or EDI transmitted claim.
c. Making necessary telephone calls or accessing claim images to resolve incomplete information from the paper and/or EDI claim.
d. Resolving any problems or contradictions with provider search issues.
e. Entering the provider data obtained to correctly add or update a provider record.
3. Perform manual or web-based repricing functions, which includes the verification of provider participation applying the appropriate reimbursement schedule and determining the correct discount amount if applicable.
a. Accessing internal or web-based databases, entering the appropriate charge information to determine the discount for each charge.
b. Entering the discounted amounts into the applicable computer system.
c. Removing items from Batch on the mainframe or other computer system.
d. Making and receiving telephone calls from providers and PPO networks regarding the status of claims network participation and discounts.
e. Researching and resolving PPO network issues for internal and external customers.
4. Perform clerical functions, including but not limited to:
a. Picking up and distributing daily reports.
b. Completing daily match of manual and EDI charges to the system generated pull lists.
c. Opening, prepping, sorting, batching and date stamping claims mail.
d. Identifying and entering appeals into the applicable computer system.
e. Accessing EDI images and printing attachments as necessary.
f. Sorting, folding and stuffing system generated letters as needed.
g. Entering Word Processing replies into the applicable computer system.
h. Retrieving authorizations and matching to the appropriate letters and faxing to the medical records retrieval vendor.
i. Preparing new file folders.
j. Printing labels as needed.
k. Preparing USPS and overnight delivery mailings as necessary.
l. Generating CANT ID, NOINS, LAPSE letters as necessary.
5. Perform file room related functions to include, but not limited to:
a. Picking up files/documents from Claims Analysts, Healthcare Management, Customer Service, QA and Training and distributing to designated area.
b. Preparing out-going mail.
c. Pulling files and documents per request received, manually, via File Request or Contact Management.
d. Interfiling documents and files into the appropriate location in the file room.
e. Searching for misplaced files.
f. Pulling items from cold storage as requested.
g. Sorting mail as needed.
h. Purging old claim files, sorting and boxing as appropriate.
i. Copying files and other documents as required.
j. Performing the faxing of documents as necessary.
k. Purging family files.
MARGINAL FUNCTIONS:
1. Manually track production and volume statistics.
2. Assist management with projects such as the collection and/or compilation of data.
3. Assist Provider Relations Coordinator in special projects as needed.
4. Provide training in entry, EDI, providers or repricing as requested.
5. Provide minor maintenance on copiers and printers.
6. Provide switchboard coverage support as needed.
7. Fax and copy items as necessary.
Job Type: Full-time
Pay: $16.00 - $17.50 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Flexible schedule
- Health insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift