Reconciliation Representative (Onsite - San Diego, CA)

American Specialty Healthorporated•San Diego, CA

10d•Onsite

About The Position

American Specialty Health Incorporated (ASH) is seeking a Reconciliation Representative for its Claims department. The role reconciles claims, including complex claims, for payment according to Explanation of Benefits from Health Plan Payors for 2-step accounts. This position requires full-time onsite office work in San Diego, California. The hourly wage range is $15.00 to $17.00; compensation depends on qualifications, education, skill set, years of experience, and internal equity. The representative handles incoming paper and electronic claim documentation, researches and reconciles claims and payments, follows up with Health Plans about claim status and errors, and documents work in internal systems and spreadsheets. The position also supports departmental production and quality goals, maintains confidentiality, collaborates with Claims Department staff, and attends required organizational and department meetings and training.

Requirements

High school diploma or GED certificate.
Two years of experience with claims processing.
Computer, typing, 10-key, and telephone skills.
Familiarity with Managed Care, HMO, and PPO health plan provisions.
Excellent listening and interpersonal communication skills.
Ability to interact respectfully and maintain cooperative working relationships.
Ability to provide excellent customer service to internal and external customers.
Ability to organize, prioritize, multitask, and manage time effectively.
Accuracy and productivity in a changing environment with constant interruptions.
Ability to analyze information, problems, issues, situations, and procedures and develop effective solutions.
Ability to maintain strict confidentiality.
Ability to see, speak, and hear personnel and/or objects; communicate verbally and in writing; travel within and around the facility or WFH environment; use a telephone, computer keyboard, and mouse; and lift up to 10 pounds.
Primarily sedentary work, including sitting for long periods.

Nice To Haves

Knowledge of Microsoft Word and Excel.

Responsibilities

Reconcile, resolve, and research 2-step claims and payments to ASH.
Receive and sort incoming mail, including paper EOBs, faxes, interoffice mail, and Health Plan letters.
Download electronic EOBs from Health Plan portals.
Count and scan EOBs and Health Plan letters for distribution and track counts in daily inventory.
Manually reconcile claims for payment from Health Plan Payors using paper EOBs or spreadsheets.
Call Health Plans to check claim status, including payment or underpayment, and request reprocessing when claims were denied in error.
Use Health Plan and TPA websites to check claim status or reconcile claims.
Reconcile claims from reports, including 14-day reports, MO copay, fee schedule, unreconciled, and rejected reports.
Notify supervisors of trends related to invalid denials by TPAs or Health Plans.
Document comments in IHIS internal notes fields and in spreadsheets being worked.
Meet department production and quality requirements.
Maintain confidentiality of claims documents, records, and claims-related issues.
Promote cooperation and understanding among personnel.
Attend organizational meetings and training as required, as well as department meetings.
Adhere to organizational policies and procedures.
Recognize unique or problematic situations within assigned responsibilities, research them, and make recommendations to the Supervisor.
Assist and collaborate with Claims Department staff on routine duties and special projects.
Perform other duties and responsibilities as assigned and comply with all policies and standards.