Claims Specialist II

Verida Inc•Villa Rica, GA

About The Position

SUMMARY: Responsible for processing and researching claims with a thorough knowledge of the company structure and claims processing procedures. Audit claims and provides feedback to both team and providers where necessary. Run, review and reconcile reports and advise leadership and Finance department of balance status. This position also reviews process trends and alerts leadership when additional training is needed. ESSENTIAL FUNCTIONS • Resolve all complex telephone and written requests requiring additional information or research and analyze situations. • Respond to provider requests within 24 hours of receipt by written correspondence (letter/email). • Interacts with all internal and external customers in a caring and respectful manner. • Understands and interprets all contracts, agreements, policies and procedures pertaining to reimbursement structure. • Provide Peer review, tutorials, and recommendations • Audit and report on claims that are processed by Claims Specialist I’s and Claims Account Representatives to management weekly. • Executes timely and accurate processing of all allocated claims. • Process a minimum of 500 claims per day • Refers questions not specifically covered in manuals or daily operations to the Team Lead. • Maintains confidentiality of patient and provider information. • Maintains protected health information in accordance with HIPAA privacy guidelines. • Train and assist Specialists by relaying instructions, messages and other information as requested by management. • Maintains a current working knowledge of all company policies, procedures, rules, regulations, memorandums and operational software. • Responsible and accountable for updating management on changes and/or extraordinary circumstances affecting the company and/or transportation provider. • Monitor and report uncommon denial analysis trends • Responsible for generating and reviewing all closing reports and prepare it for management review • Other duties as assigned

Requirements

Listens and communicates clearly, professionally, and empathetically.
Excellent communications skills in both oral and written.
High Level of Professionalism, attention to detail.
Professional telephone etiquette including excellent verbal communication skills and use of proper grammar.
Strong work ethic and self-starter, able to effectively manage multiple priorities and adapt to change within a fast-paced business environment.
Excellent listening skills and the ability to ask probing questions, understand concerns, and overcome objections.
Ability to foster positive working relationships across all departments
Highly organized, displays strong attention to detail and accuracy.
Intermediate level proficiency in Windows (Microsoft Word and Excel is a must)
Must have 8,000 kspm
Able to function effectively in demanding situations
Knowledge of Southeastrans Reconciliation Process, Claims policies and procedures
Knowledge of Medicaid Non-Emergency Transports
Able to handle multiple tasks simultaneously
Able to lift and/or move items up to 25 pounds
Able to work with a group or independently
High School diploma or equivalent
Two or more years’ experience processing claims

Nice To Haves

Associate Degree preferred

Responsibilities

Resolve all complex telephone and written requests requiring additional information or research and analyze situations.
Respond to provider requests within 24 hours of receipt by written correspondence (letter/email).
Interacts with all internal and external customers in a caring and respectful manner.
Understands and interprets all contracts, agreements, policies and procedures pertaining to reimbursement structure.
Provide Peer review, tutorials, and recommendations
Audit and report on claims that are processed by Claims Specialist I’s and Claims Account Representatives to management weekly.
Executes timely and accurate processing of all allocated claims.
Process a minimum of 500 claims per day
Refers questions not specifically covered in manuals or daily operations to the Team Lead.
Maintains confidentiality of patient and provider information.
Maintains protected health information in accordance with HIPAA privacy guidelines.
Train and assist Specialists by relaying instructions, messages and other information as requested by management.
Maintains a current working knowledge of all company policies, procedures, rules, regulations, memorandums and operational software.
Responsible and accountable for updating management on changes and/or extraordinary circumstances affecting the company and/or transportation provider.
Monitor and report uncommon denial analysis trends
Responsible for generating and reviewing all closing reports and prepare it for management review
Other duties as assigned