JOB SUMMARY
Process/load JMS files daily for all Senior, Commercial, Medical and all Institutional claims to EZ-Cap database.
Review all the rejections and regenerations daily.
Process/load Office Ally files for all Senior, Commercial, Medical and all Institutional claims to Ez-Cap database.
QUALIFICATIONS
· Minimum five (5) years’ experience in the healthcare management managed care environment required; including third-party contracting, negotiating, reimbursements and analysis.
· Minimum three (3) years of experience in a management capacity.
· Preferred experience in managing analyzing and reporting denials and appeals.
SKILLS
· Must have effective communication, facilitation, interpersonal and professional diplomacy skills.
· Strong attention to detail with ability to manage multiple priorities while meeting deadlines.
· Able to Problem-solve, negotiate and demonstrate independent decision-making.
· Strong communication skills in both oral and written form.
· Positive attitude and takes a team approach to management.
· Maintain strong skills in diplomacy, professionalism and trustworthiness.
· Familiarity with Microsoft applications, which include the ability to learn new computer systems and applications.
· Ability to manage multiple priorities and projects.
· Detail oriented with desire for producing work with 100% accuracy.
· Excellent analytical and problem-solving skills.
JOB DUTIES
SECTION I
1. Load Electronic Claims submitted through office ally within 2 business days.
2. Load Paper Claims submitted in paper within 15 calendar days.
3. Regenerations (Pended Provider and Eligibility issues)
4. For all terminated provider need to update bowman
5. Solve issues in a timely manner when they occur
6. Communication with Vendors for any issues/errors
7. Responsible for HIPPS/Diagnosis/Codes not in Ez-Cap
8. Review reports daily for reconciliation of claims submitted and received. Reports must be submitted to JMS daily.
Job Type: Full-time
Pay: $21.00 - $26.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
