Participant Claims Liaison

community care of wny inc•Olean, NY

1d•$19 - $21•Onsite

About The Position

Under assigned supervision by the Associate Program Director/Center Manager, is responsible for, but not limited to processing medical claims and interacting with providers on a routine basis.

Requirements

Training and knowledge of medical records technology, claims processing, or equivalent program or high school diploma and four years of related experience in a medical records and/or medical claims processing environment, or equivalent combination of experience and education.
2 years (or minimum of related experience above) of related work experience in a healthcare environment and processing of medical claims; skilled in computer operations and use/application of Microsoft Office software; and demonstrated organizational abilities.
Possesses strong/broad understanding of the claims analyst process, medical terminology, and claims processing procedures.

Nice To Haves

Effective verbal and written communication skills
strong attention to detail
organizational skills
customer service and telephone skills including receiving incoming calls and contacting external physician offices
familiarity and competence with standard office machines such as copier, calculator, fax machine, etc.
acceptable driver’s license and use of automobile during working hours
Healthcare experience in a managed care organization, preferred.

Responsibilities

Processes medical claims received from Providers for payment.
Reviews and verifies medical records both electronic and hard copy ensuring accuracy and completeness.
Evaluates system coding to validate pricing and claims payments to ensure claims are processed in accordance with provider contracts, participant benefits, and authorization requirements.
Manages claims inquiries and individual Provider requests.
Requests participant information/reports from specialist, health care facilities and other providers.
Analyze claims and data to improve operational efficiency, productivity, and accuracy.
Act as a subject matter expert for claims system functionality and capabilities.
Manage underpayment/overpayment recovery processes to ensure claims are reprocessed in a timely manner.
Monitor mis-paid claims, develop, and implement ongoing tracking mechanisms and recommend activities to reduce/avoid mis-paid claims from re-occurring.
Maintains confidentiality.
Adheres to and reflects organizational values in daily work.
Serves on agency committees as may be assigned.
Maintains an obligation to report wrongdoing/violation of agency policies, applicable federal, state and local laws, and rules and regulations, pertaining to agency operations, to immediate supervisor or identified compliance officer.
Completes all mandatory in-service education programs and completes any other additional in-service hours that are minimally required for the position.