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Pend Management Supervisor Jobs (NOW HIRING)

1199SEIU Funds

Manager, Hospital Claims

Manhattan, NY · On-site

... Supervisors in overseeing work distribution and completion; optimizing workflows; monitoring ... Management System (DMS), QNXT Pend Workflow, and QNXT Call Tracking systems Assist in the ...

CYNET SYSTEMS

Claims Processor

Mason, OH · On-site

$20 - $22/hr

Maintains the Medicare/Medicaid Pend Claims process. * Participates on special project initiatives ... Works with supervisor and co-workers to provide strong customer service and communication with key ...

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Office/Administration - Claims Processor

Mason, OH • On-site

Real Soft, Inc.
IT Services • 501 - 1,000 employees
Learn more about Real Soft, Inc.external

$30/hr

Other

Posted 14 days ago

Job description

Coordinator - Claims
• Job Description(s): ATTACHED
• Bill Rate: $30.00
• Mark up 33.05%
• 13th month tenure discount 22.50%
• OIG/GSA and Background screenings required
• $2000.00 Missing Equip fee if not returned
• Work hours: full-time (8h day / 40 week). Standard 9am-5pm
• Brand: Shared Services
• Temp or Temp to Hire role: TEMP ONLY
• Start date: ASAP
• Length of assignment: TBD - Temp
• Location Address: 4000 Luxottica Place, Mason, OH, 45040
o Remote or Onsite: Onsite
• If onsite, please indicate if hybrid or workplace only: Hybrid (3 days in office, 2 days for home)
• Specific Skills Needed:
o Top 3-5 mandatory and/or minimum requirements: see JD attached
o Top 3-5 desirable attributes/qualifications?: see JD attached
o Required levels/ Years of Experience education - discuss whether there is flexibility: see JD attached
• Reason for request (Example: project base, staff augmentation, replacement or other). Can you please provide 4-5 detailed sentences as to why this temp labor is needed and why the assignment can not be completed by an internal resource? The more details that you can provide the better your chances are of avoiding delays. :These 4 roles will be to support a new project, Archee. As volume increases, we want to ensure we have temps in place to support the activity, and if all goes well - convert them to perm.
GENERAL FUNCTION
The Claims Coordinator accurately and efficiently processes all types of claims from source documents, maintaining compliance with the insurance plan requirements and with high regard for adhering to goals for quality and claims production rates. Also performs other complex claim processing which include but not limited to Medicare/Medicaid Pend process, Corrected Claims, and running daily reports.
MAJOR DUTIES AND RESPONSIBILITIES
• Efficiently and accurately processes a variety of vision insurance claims or adjustments.
• Determines any special plan requirements prior to billing.
• Reviews claims before entry for completeness and compliance with business requirements.
• Effectively and accurately reviews images and transcribed data in the portal in preparation for auto adjudication.
• Coordinate and complete claim error corrections
• Maintains the Medicare/Medicaid Pend Claims process
• Participates on special project initiatives, including rework efforts as needed.
• Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
• Maintains compliance with HIPAA guidelines and regulations.
• Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
• Assists Team Lead in a backup lead capacity
• Assists with root cause analysis of claim issues to resolve thoroughly and completely for clients
• Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.
BASIC QUALIFICATIONS
• High School diploma or equivalent work experience
• 3+ year(s) of data entry experience
• Strong customer service focus
• Strong verbal & written communication skills
• Able to multi-task and prioritize issues
• Strong attention to details
PREFERRED QUALIFICATIONS
• Knowledge of Medicare/Medicaid business
• Knowledge of vision benefits and/or insurance industry
• Proficient in Microsoft Word, Excel and Access

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