Maintain accurate data entry of 199SEIU member information in hospital claims processing system (QNXT)
Track and ensure completeness of daily inquires; ensure they are sent to appropriate payment area for adjustment including but not limited to DMS (Data Management System)
Scan and archive documents into DMS (Data Management System)
Mail and maintain reconsideration letters including maintaining of acknowledgement of reconsideration letters
Track misdirected provider inquiries received from internal departments within the Fund, enter memo into QNXT and upload document to DMS (Data Management System)
Handle claim pending with edits for preparation of external transmission files, including review of aged edit(s), retrieval, and assignment of determination of incoming transmission files, follow up, sort and data entry of transmission files related information as needed
Review and maintain daily utilization management of claims and/or documents to ensure information is accurate and loaded in the claims system are correct, including updating memos and internal tracking logs with determination
Maintain monthly invoice report to ensure information is accurate and determinations loaded into claims processing system are correct; including updating memos of provider inquiries and medical records received, revised DRG received as well as claims processing/payment information; update internal spreadsheet tracker with claim determination
Communicate and follow up with external provider and/or vendor via telephone and/or email
Provide clerical support to the Hospital Claims department including but not limited to handling of mail filing, typing, photocopying, faxing, deliveries, etc.
Perform additional duties and special projects assigned by management
Qualifications:
High School Diploma or GED required, some College or Degree preferred
Minimum two (2) years clerical experience in a general office environment requiredli>
Basic skill level in Microsoft Excel and Word preferred
Excellent data entry skills required
Knowledge of hospital claims system (QNXT) and ability to check hospital claims history and eligibility
Excellent oral and written communication skills
Demonstrated organizational skills with ability to multi-task and follow up
Problem solver with ability to work independently and as a team player
