Claims Administrator

Verida Inc•Villa Rica, GA

19h

About The Position

Assist with the management of non-emergency Medicaid and MCO transportation claims workload through ongoing assessment, assistance, and staff supervision. Responsible for developing and conducting a variety of training programs and/or auditing tools. This position will serve as the resource to the Claims Specialists, the provider relations/support group, and providers to improve performance in accordance with the Southeastrans guidelines.

Requirements

Healthcare, Medicaid and MCO, claims experience a plus
Must adhere to HIPAA standards.
Ability to use standard office equipment including copiers, fax machines, phones, and computer hardware and software.
Displays written and verbal communication skills with executive management and staff, and is able to follow written and oral instructions.
Ability to process, formulate and modify policies; train and direct staff.
Strong customer service focus and the ability to work with a diverse group of internal and external customers.
Possesses good organizational skill and the ability to focus on assigned tasks.
Able to work collaboratively, diplomatically, and with integrity in problem identification and problem-solving activities.
Displays knowledge of ethical principles and compliance issues in an accounting setting.
Ability to foster positive working relationships across all departments.
Able to handle highly confidential and sensitive information.
Highly organized, displays strong attention to detail and accuracy.
Ability to multi-task giving attention to deadlines. Capacity to diffuse difficult situations.
Self-motivated/self-starter, can take initiative, can work independently without supervision and can step in to support other department initiatives.
Must be able to provide positive reinforcement to the team and encourage the team in a positive manner in all aspects.
Intermediate-level proficiency in Microsoft Word and Excel.
Ability to work extended hours when workload necessitates.
Professional appearance.
Must be able to travel occasionally
Bachelor’s Degree in Business or a related field.
Must have three years of Training experience.
Must have three to five years of experience formulating training curriculum.
Must have three to five years of experience using multimedia visual aids.

Responsibilities

Identify ways of improving the efficiency and effectiveness of employees.
Oversees, trains, and evaluates the performance of staff.
Provide feedback on revisions to policy and procedures and work process development.
Process NET claims, Identify and investigate potential fraud.
Demonstrates the ability to interpret and apply plan-specific contract provisions.
Establish and foster fluid verbal and written communication exchanges with transportation providers, state healthcare partners, external and internal customers.
Assist transportation providers' requests and complaints regarding billing submissions.
Assist with projects, development of reports, and perform other program related duties as assigned by the Leadership Team.
Represent the organization at transportation provider meetings, professional association meetings and workshops.
Formulate training curriculum; develop targeted instructional methods such as individual training, group instruction, demonstrations and workshops.
Develop and maintain training materials such as handbooks, demonstration models, multimedia visual aids, computer tutorials, and reference workshops.
Partner with management to develop and execute scheduled specialized training sessions focused on system enhancements, workflow changes, new products or product changes as well as policy/procedure changes.
Conduct training needs analysis to determine specific training needs for department staff and evaluate effectiveness.
Conduct appropriate training programs, including selecting and designing appropriate training aids.
Research, analyze and recommend external training programs
Maintain records of training activities and employee progress.
Audit work and coordinate training initiatives to identify, develop and publish corrective actions and educational materials.
Other duties as assigned.